Understanding Urge Urinary Incontinence in Women
Urge urinary incontinence (UUI) is common in women, and it’s treatable. This page covers what UUI is, what causes it, how it’s diagnosed, and how it’s treated.
What is Urge Urinary Incontinence?
Urge urinary incontinence is the involuntary loss of urine associated with a sudden, strong desire to urinate. That usually means:
- A sudden, intense urge to urinate
- Urine leakage before reaching the bathroom
It is commonly associated with:
- Frequent urination (more than 8 times in 24 hours)
- Nocturia (waking up to urinate at night)
Key Point
With UUI, you may feel like you have little to no control over your bladder. Leaks can come without warning, and some are large.
How Common is Urge Urinary Incontinence?
UUI is more common than many women realize:
- Affects approximately 17% of women over 40
- Incidence increases with age, and overactive bladder symptoms pass 30% in women 65 and older
- Often coexists with stress urinary incontinence (known as mixed incontinence)
UUI is common, but it is not a normal part of aging. It’s a medical condition, and you can manage it effectively with treatment.
Causes and Risk Factors
Urge urinary incontinence occurs when the bladder muscle (detrusor) contracts involuntarily. Several factors can contribute to this:
- Neurological disorders: Such as multiple sclerosis, Parkinson’s disease, or stroke
- Bladder abnormalities: Like tumors or stones
- Urinary tract infections: Can cause temporary UUI symptoms
- Hormonal changes: Especially during menopause
- Certain medications: Some drugs can affect bladder function
- Excessive caffeine or alcohol intake: Can irritate the bladder
- Obesity: Excess weight can put pressure on the bladder
- Aging: Natural changes in the bladder can increase risk
Most of the time no single cause turns up, which doctors call idiopathic. Not finding a cause doesn’t change the treatment options.
Symptoms of Urge Urinary Incontinence
The primary symptoms of UUI include:
- Sudden, strong urge to urinate that’s difficult to control
- Involuntary loss of urine immediately following or accompanied by an urgent need to urinate
- Leaking large amounts of urine
Certain triggers set it off for a lot of women: the sound of running water, cold weather, anxiety, or putting a key in the front door. That last one is common enough to have its own name, latchkey incontinence.
Did you know?
When urge incontinence coexists with urinary frequency (urinating more than 8 times in 24 hours), the condition may be referred to as overactive bladder (OAB) with incontinence or “OAB wet”. This distinguishes it from OAB without incontinence, also known as “OAB dry”.
Diagnosis
If you’re experiencing symptoms of UUI, see a healthcare provider. Diagnosis typically involves:
- Medical history: Your doctor will ask about your symptoms, medical background, and lifestyle
- Physical examination: To check for any physical abnormalities or pelvic organ prolapse
- Urinalysis: To rule out urinary tract infections or other issues
- Bladder diary: You may be asked to keep a log of your fluid intake, urination frequency, and incontinence episodes
- Urodynamic testing: In some cases, to measure bladder pressure and urine flow
- Cystoscopy: A scope may be used to examine the inside of your bladder and urethra
Treatment Options
Effective treatments include lifestyle changes, medications, and more advanced therapies:
Conservative Treatments
- Bladder training: Techniques to increase the time between feeling the urge to urinate and passing urine
- Pelvic floor exercises (Kegels): Can help improve bladder control
- Double voiding: Urinating, waiting a few moments, then trying again to empty the bladder more completely
- Scheduled toilet trips (aka Timed voiding): Going to the bathroom at set times, rather than waiting for the urge
When an urge hits, squeezing the pelvic floor muscles a few times can calm the bladder through a reflex. That buys time to walk to the bathroom instead of running.
Lifestyle Changes
- Fluid management: Avoiding bladder irritants like caffeine and alcohol
- Weight loss: If overweight, losing excess pounds can reduce pressure on the bladder
- Dietary modifications: Avoiding foods that may irritate the bladder
Medications
- Antimuscarinics: Help relax the bladder muscle (e.g., oxybutynin, tolterodine)
- Beta-3 agonists: Improve the bladder’s ability to store urine (e.g., mirabegron, vibegron)
- Topical estrogen: For postmenopausal women, may help improve urethral and vaginal tissue health and decrease bladder irritation
Fewer than half of women are still taking an anticholinergic at six months, mostly because of dry mouth and constipation. For women 65 and older I usually start with a beta-3 agonist, because anticholinergics are on the list of drugs older adults should avoid out of concern for memory and dementia risk.
Advanced Therapies
- BOTOX injections: Your doctor injects botulinum toxin into the bladder muscle. It relaxes the muscle and reduces involuntary contractions, which improves symptoms of overactive bladder and urge urinary incontinence. The effect typically lasts about 6 to 9 months, and you can repeat the injections after that. In a trial comparing it with daily anticholinergic pills, 27% of women who got Botox stopped leaking entirely, compared with 13% on pills. About a third got a urinary tract infection, and 5% needed to use a catheter for a while because the bladder didn’t empty well.
- Percutaneous and implantable tibial nerve stimulation: A minimally invasive treatment that uses electrical pulses to stimulate nerves in the ankle. This can improve bladder control by changing the nerve signals that control the bladder. In the SUmiT trial, 55% of patients reported moderate or marked improvement after 12 weekly sessions, compared with 21% after a sham treatment.
- Sacral neuromodulation: A small implanted device sends mild electrical pulses to the sacral nerves, which help control bladder and bowel function. It can improve symptoms of overactive bladder and difficulty emptying the bladder. Over two years, sacral neuromodulation and Botox cut leaks by about the same amount, and urinary tract infections were less common with the implant (10% vs 24%).
Remember
No single plan fits everyone. Your healthcare provider will work with you to find the approach that fits your situation.
Living with Urge Urinary Incontinence
While you work on treatment, these habits can make daily life easier:
- Locate bathrooms before you need them when out in public
- Wear easily removable clothing for quick bathroom access
- Use absorbent products for peace of mind
- Practice relaxation techniques when you feel the urge to urinate
- Stay hydrated, but limit fluids before bedtime
Take Action!
If you’re experiencing symptoms of urge urinary incontinence:
- Don’t be too embarrassed to discuss with your doctor. It’s a common, treatable medical condition
- Keep a bladder diary to share with your healthcare provider
- Schedule an appointment with a urogynecologist or pelvic health specialist
- Be open about your symptoms and how they affect your quality of life
You’re Not Alone
Many women have found relief from urge urinary incontinence. If leaks are shaping your day, make an appointment.
Urge urinary incontinence is common, but you don’t have to accept it as a normal part of life. With treatment, you can significantly improve your symptoms and quality of life.
References
- Lukacz ES, Santiago-Lastra Y, Albo ME, et al. Urinary Incontinence in Women: A Review. JAMA. 2017. doi:10.1001/jama.2017.12137
- Lightner DJ, Gomelsky A, Souter L, et al. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019. The Journal of Urology. 2019. doi:10.1097/JU.0000000000000309
- ACOG Committee on Practice Bulletins—Gynecology, American Urogynecologic Society, Kenton KS, et al. Urinary Incontinence in Women (ACOG Practice Bulletin No. 155). Obstetrics & Gynecology. 2015. doi:10.1097/AOG.0000000000001148
- Dengler KL, High RA, Moga DC, et al. Overactive Bladder and Cognitive Impairment: The American Urogynecologic Society and Pelvic Floor Disorders Research Foundation State-of-the-Science Conference Summary Report. Urogynecology. 2023. doi:10.1097/SPV.0000000000001272
- White N, Iglesia CB. Overactive Bladder. Obstetrics and Gynecology Clinics of North America. 2016. doi:10.1016/j.ogc.2015.10.002
- Amundsen CL, Richter HE, Menefee SA, et al. OnabotulinumtoxinA vs Sacral Neuromodulation on Refractory Urgency Urinary Incontinence in Women: A Randomized Clinical Trial. JAMA. 2016. doi:10.1001/jama.2016.14617
- Peters KM, Carrico DJ, Perez-Marrero RA, et al. Randomized Trial of Percutaneous Tibial Nerve Stimulation Versus Sham Efficacy in the Treatment of Overactive Bladder Syndrome: Results From the SUmiT Trial. The Journal of Urology. 2010. doi:10.1016/j.juro.2009.12.036
- Faubion SS, Kingsberg SA, Clark AL, et al. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020. doi:10.1097/GME.0000000000001609
- Visco AG, Brubaker L, Richter HE, et al. Anticholinergic Therapy vs. OnabotulinumtoxinA for Urgency Urinary Incontinence. New England Journal of Medicine. 2012. doi:10.1056/NEJMoa1208872
- Amundsen CL, Komesu YM, Chermansky C, et al. Two-Year Outcomes of Sacral Neuromodulation Versus OnabotulinumtoxinA for Refractory Urgency Urinary Incontinence: A Randomized Trial. European Urology. 2018. doi:10.1016/j.eururo.2018.02.011
- Sanses TVD, Zillioux J, High RA, et al. Evidence-Informed, Interdisciplinary, Multidimensional Action Plan to Advance Overactive Bladder Research and Treatment Initiatives. Urogynecology. 2023. doi:10.1097/SPV.0000000000001274