Urge Incontinence (Urgency Urinary Incontinence)
This patient has urge urinary incontinence (UUI), defined as involuntary leakage of urine accompanied by or immediately preceded by a sudden, compelling desire to void that is difficult to defer. 1, 2
Defining Characteristics
The two essential elements that distinguish urge incontinence are: 2
- Urgency: A sudden, compelling desire to pass urine which is difficult to defer 1
- Involuntary leakage: Uncontrolled loss of urine that occurs with or immediately before this urgency sensation 2
This presentation is the hallmark of overactive bladder (OAB) with urgency urinary incontinence, where the bladder muscle contracts involuntarily, leading to the inability to reach the bathroom in time. 1
Distinguishing from Other Incontinence Types
Stress urinary incontinence presents differently—it involves involuntary leakage with physical exertion, sneezing, or coughing, without the preceding urgency sensation. 3, 4
Mixed urinary incontinence combines both stress and urge components, where patients experience leakage both with physical activity AND with urgency episodes. 2, 5
Overflow incontinence typically presents with continuous dribbling or leakage without strong urgency, often with incomplete bladder emptying and elevated post-void residual volumes (>250-300 mL). 6
Critical Diagnostic Pitfall
A common and dangerous mistake is misdiagnosing overflow incontinence as urge incontinence, which can lead to inappropriate treatment with antimuscarinic medications that worsen urinary retention. 6 Always measure post-void residual in patients presenting with incontinence to avoid this error. 6
Associated Symptoms
Patients with urge incontinence typically also report: 1
- Urinary frequency: More than seven micturition episodes during waking hours 1
- Nocturia: Waking one or more times at night to void 1
- Small volume voids (unlike the normal or large volume voids seen in nocturnal polyuria) 1
Next Steps in Evaluation
Before confirming the diagnosis, exclude other conditions through: 1