Definition of Urge Incontinence
Urge urinary incontinence is defined as involuntary leakage of urine accompanied by or immediately preceded by urgency. 1
Key Components of Urge Incontinence
Urge incontinence consists of two essential elements:
- Urgency: A sudden, compelling desire to pass urine or a strong need to pass urine for fear of leakage 1
- Involuntary leakage: The uncontrolled loss of urine that occurs with this urgency sensation 1
Distinguishing Urge Incontinence from Other Types
Urge incontinence must be differentiated from other types of urinary incontinence:
- Stress urinary incontinence: Involves involuntary urine loss during events that increase abdominal pressure (coughing, sneezing, physical exercise) 1, 2
- Mixed urinary incontinence: Combination of both stress and urge urinary incontinence symptoms 1
Clinical Context
Urge incontinence is often associated with:
- Overactive bladder syndrome: A constellation of symptoms including urinary urgency (with or without urge incontinence), usually accompanied by frequency and nocturia 1
- Frequency: Urinating often, typically with small volume voids 1, 3
- Nocturia: Waking at night to urinate due to urgency 1, 3
Prevalence and Impact
- Urge incontinence accounts for approximately 33% of urinary incontinence cases in women 4
- It significantly impacts quality of life and can lead to social isolation, embarrassment, and decreased activity 1, 3
- The condition contributes to substantial healthcare costs and can be a factor in nursing home admissions 1
Diagnostic Considerations
When evaluating a patient with suspected urge incontinence:
- A positive diagnosis is based on the patient's description of involuntary leakage preceded by urgency 2
- Simple questionnaires like the 3 Incontinence Questions (3IQ) can help distinguish between urge and stress incontinence with acceptable accuracy (sensitivity of 0.75 and specificity of 0.77 for urge incontinence) 5
- Urinary diaries documenting frequency, urgency episodes, and incontinence episodes are helpful in confirming the diagnosis 1
Treatment Approach
For patients diagnosed with urge incontinence:
- First-line therapy: Bladder training (behavioral therapy that includes extending time between voiding) 1
- Second-line therapy: If bladder training is unsuccessful, pharmacologic treatment with muscarinic receptor antagonists (e.g., tolterodine) is recommended 1, 6
- Adjunctive measures: Weight loss and exercise for obese women with urinary incontinence 1
Understanding the precise definition and characteristics of urge incontinence is essential for proper diagnosis and effective treatment selection.