How to treat urge incontinence

Written by: Mr Rajesh Kavia
Published:
Edited by: Laura Burgess

Urge incontinence (also known as overactive bladder syndrome or irritable bladder) is the sudden, strong need to urinate. It is one part of the framework of urinary incontinence. In many cases, it is difficult to diagnose the exact cause of urge incontinence but it could be because of any of the following underlying conditions: a bladder infection, inflammation, an enlarged prostate in men, or an obstruction to the opening of the bladder.

What are the treatments available for urge incontinence?

There are lifestyle changes that can be made to eliminate urge incontinence. The following is recommended for those who suffer from an irritable bladder:
 

  • Cut down on caffeine – limit tea and coffee intake and try to eliminate it overall.
  • Bladder retraining – the goal is to cut back on the number of times urine is passed, down to 6-8 times in a 24-hour period. This is done by increasing the time between toilet trips. It may seem difficult at first but becomes easier as the bladder adjusts.​​
  • Tablets – medication such as anticholinergics or Betmiga can relax the bladder and prevent bladder spasms.

​​However, if the symptoms of an irritable bladder do not improve following these methods, Botox®, sacral nerve stimulation or posterior tibial nerve stimulation are other options.
 

Botulinum toxin® injections

In cases of urge incontinence, Botulinum toxin® (Botox) can be injected into the sides of the bladder to help it to relax. This effect can last for several months and can be repeated if the injections are helpful. Although the symptoms of incontinence may improve following the injections, it may be difficult to fully empty the bladder. If this happens, then the patient will need to be taught how to insert a thin, flexible tube (a catheter) into their urethra to drain the urine from the bladder.

Botox® is licensed to treat urge incontinence or overactive bladder syndrome.

Sacral nerve stimulation

The sacral nerves (at the bottom of the back) carry signals from the brain to some of the muscles that are used when going to the toilet, such as the detrusor muscle, which surrounds the bladder. If the detrusor muscles contracting too often are the cause then sacral nerve stimulation (sacral neuromodulation) may be recommended to treat urge incontinence.

A device is inserted near one of the sacral nerves, which is usually in one of the buttocks. An electrical current is sent from this device into the nerve. This should improve the way signals are sent between the brain and the detrusor muscles to reduce urges to urinate.

Sacral nerve stimulation can result in substantial improvement in their symptoms or the end of their incontinence completely, but occasionally people can have some pain.
 

Posterior tibial nerve stimulation

The posterior tibial nerve runs down the leg to the ankle and contains nerve fibres that start from the same place as the nerves that run to the bladder and pelvic floor.

Stimulating the tibial nerve affects these other nerves and helps control bladder symptoms, including the urge to pass urine. A very thin needle is inserted through the skin of the ankle and a mild electric current is sent through it, which causes a tingling feeling and the foot to move. The patient may need 12 sessions of stimulation, each lasting around half an hour, one week apart.

Some studies have shown that this treatment can offer relief from overactive bladder syndrome and urge incontinence for some people but there isn't enough evidence yet to recommend tibial nerve stimulation as a routine treatment. It is only recommended in a few cases where urge incontinence hasn't improved with medication and the patient doesn’t want to have Botox® injections or sacral nerve stimulation.

 

 

If you are suffering from irritable bladder syndrome, do not hesitate to book an appointment with a specialist

By Mr Rajesh Kavia
Urology

Mr Rajesh Kavia is a leading London consultant urological surgeon, with a special interest in functional urology and incontinence in males and females. He treats all manner of urological problems from his private clinics across London, and was the first surgeon within the M25 to perform the Urolift procedure to treat benign prostate obstruction, using minimally invasive surgical techniques.

Mr Kavia has undertaken extensive research in a number of urological conditions, such as being the lead author on a multinational trial of cannabis for multiple sclerosis-related overactive bladder syndrome, and in painful bladder syndrome at the National Hospital for Neurology and Neurosurgery. Alongside his clinical and research work, Mr Kavia dedicates time to teaching junior doctors, and is a course director and examiner for higher surgical trainees, he has also published numerous articles in peer-reviewed medical journals.

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