From the Guidelines
Urge incontinence is most commonly caused by overactive bladder (OAB), where the bladder muscle contracts involuntarily, as defined by the International Continence Society (ICS) in the presence of “urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence (UUI), in the absence of urinary tract infection or other obvious pathology” 1. The primary causes of urge incontinence include:
- Neurological conditions like multiple sclerosis, Parkinson's disease, stroke, or spinal cord injuries that disrupt normal bladder control signals
- Bladder irritants such as urinary tract infections, bladder stones, or bladder cancer that can trigger sudden urges
- Age-related changes to the bladder muscle and nervous system that contribute significantly to the development of OAB
- Hormonal changes during menopause in women that can affect bladder control
- Certain medications, particularly diuretics, that can worsen symptoms
- Excessive fluid intake, especially caffeine and alcohol, that irritates the bladder and increases urgency
- Obesity that places additional pressure on the bladder
- Constipation that can mechanically interfere with bladder function
- Diabetes that may cause urge incontinence through nerve damage and increased urination According to the American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) guideline amendment 2019, the diagnosis and treatment of OAB should focus on the presence of bothersome urinary symptoms, including urgency, frequency, and nocturia 1. Treatment typically begins with behavioral modifications like timed voiding and fluid management, followed by medications such as anticholinergics (oxybutynin, tolterodine) or beta-3 agonists (mirabegron) if needed, as recommended by the American College of Physicians (ACP) in their clinical practice guideline for the nonsurgical management of urinary incontinence in women 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Causes of Urge Incontinence
The most common causes of urge incontinence can be attributed to various physiopathologic conditions, including:
- Ageing 2
- Diabetes mellitus 2
- Bladder outlet obstruction 2
- Spinal cord injury 2, 3
- Stroke and brain injury 2, 3
- Parkinson's disease 4, 2, 3
- Multiple sclerosis 5, 6, 2, 3
- Interstitial cystitis 2
- Stress and depression 2
Neurological Conditions
Neurological conditions such as multiple sclerosis, spinal cord injury, Parkinson's disease, and stroke can lead to neurogenic overactive bladder (nOAB), which is a common cause of urge incontinence 3. The prevalence of urinary incontinence (UI) in patients with these conditions is significant, with estimated prevalence rates of:
- 50.9% in patients with multiple sclerosis 3
- 52.3% in patients with spinal cord injury 3
- 33.1% in patients with Parkinson's disease 3
- 23.6% in patients with stroke 3
Treatment Options
Treatment options for urge incontinence due to overactive bladder symptoms include: