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Urge incontinence is a type of urinary (or fecal) incontinence caused by a sudden and strong sensation of needing to void. This post provides more insight into the causes of urge incontinence and holistic treatment options.

What can urge incontinence look like?

1. Leaking urine when you hear running water
2. Inability to hold urine when getting into a pool or shower
3. Rushing to the bathroom with a strong feeling to “go”
4. Going to the bathroom every hour or less during the day or night
5. Having urinary leakage caused by a strong need to empty the bladder
6. Waking up multiple times a night to void
7. Getting a strong urge to “go” with an inability to delay
8. Leaking on the way to the toilet

Why does Urge incontinence happen?

Urge incontinence happens when the urge to void overcomes the pelvic floor muscles’ ability to control and stabilize the bladder. The bladder contracts suddenly and strongly, and urine leaks out!

What contributes to developing urge incontinence?:

• Certain voiding habits (see below)
• Stress, anxiety, nervousness
• Overactive bladder
• Frequent UTIs
• Pelvic floor muscle tightness
• Pelvic floor muscle weakness
• Diet
• Irritable bowel syndrome
• Brain-bladder communication (up-regulation of the nervous system)
• Not drinking enough water
• Water:caffeine ratio

Common Voiding Habits that could contribute:

• Going to the bathroom “just in case.”
• Going to the bathroom multiple times before leaving the house
• Going to the bathroom right away upon arrival
• Going to the bathroom whenever you see one
• “Going” multiple times before bed
• Rushing to the toilet when you feel the urge
• Voiding each time you take a shower
• Rushing to the toilet when you hear running water, such as when doing the dishes.

How often is too often to pee?

Normal values:

• Daytime: Every 2-5 hours or 6-8 times a day
• Nighttime:
  • Before menopause= 0-1 time a night
  • After menopause= 1-2 times a night
• In the morning, you may void a little more frequently, but the interval between voids should still be at least 1 hour.

How much water should i drink in a day?

There are differing opinions on this question. I’m sticking with a rough estimate of: 1/2 of your body weight (lbs) in ounces of water. Add 10 ounces if you live in a humid or warm environment, and add 10 more ounces if you did physical activity that day. Keep in mind that your water intake should be the same or more than your caffeine intake. So if you drink 1 cup of coffee, you should at least drink 1 cup of water. This is because coffee is acidic, and if your urine is more concentrated and less diluted, that will be more irritable to your bladder and will cause a stronger urge.

What is the brain-bladder connection?

The urinary system is an involuntary system. We cannot make our bladder contract, it just does so on it’s own, controlled by an area of the brain, called the pons. As the bladder fills, your brain is telling the bladder muscle to relax and the pelvic floor muscles to contract to prevent leaking. And then once the bladder is full, the brain tells the bladder muscle to contract to empty and the pelvic floor muscles to relax. Sometimes this gets a little off, and urge incontinence can result.

Basic Anatomy of the Urinary system and pelvic floor:

The bladder is a very important muscular organ that sits in the front of the pelvic bowl. It is where urine is stored. The urinary system (from the top down) comprises the kidneys, ureters, bladder, and urethra.

In the pelvic girdle, the bladder is in front, the vagina is behind the bladder with the uterus above, and the rectum is behind the vagina. The pelvic floor muscles are the support system below, and they surround the openings of the urethra, vagina, and rectum.

If the bladder contracts so strongly that the pelvic floor muscles are unable to control it, leakage can occur.

is urge incontinence the same as overactive bladder?

I would say that urge incontinence is a symptom of overactive bladder, when the overactivity of the bladder causes urine leakage. Overactive bladder may not always be associated with incontinence.

Is Urge incontinence and urgency a result of Interstitial Cystitis?

It can be but not always. Interstitial Cystitis (or IC) is a chronic bladder condition in which the bladder is extra sensitive. The bladder sends signals to the brain to empty at a much lower volume than normal, resulting in frequent trips to the bathroom. There can also be mild to severe pain associated with IC, which is also referred to as “bladder pain syndrome.”

Interstitial Cystitis can have similar symptoms as urge incontinence or overactive bladder, such as urinary frequency and urgency.

How can physical therapy treat urinary urge incontinence?

1. Identify and correct pelvic floor muscle dysfunction involved.
2. Provide insight for understanding the bladder, brain, and pelvic floor muscle relationship.
3. Assessment and interpretation of a bladder diary to assess voiding habits of a typical day
4. Interpretation of diet and fluid intake to see what could be contributing to symptoms.
5. Establish an appropriate plan of treatment based on findings during the initial evaluation. 

Depending on the severity of your symptoms, urge incontinence/ OAB can be resolved with just a few visits to a pelvic health physical therapist.  Physical therapists who specialize in pelvic health are trained to treat various types of bladder and bowel dysfunctions, and urge incontinence is a common one! I have found in my practice that there is empowerment in the understanding of the bladder and how it interacts with the brain and the pelvic floor muscles.  I know it sounds crazy that the brain would be connected with the bladder and the bladder with the pelvic floor, but it’s true!  All 3 are in constant communication to function appropriately, and they need a little help when the system gets altered. This is a great option for a holistic approach to normalizing bladder function!

Look Out For This Book:

If any of this article resonates with you, this book may be a great resource for you.

In this book you will find:

• Urge Questionnaire
• Explanation and definitions
• Common causes of urinary urgency, frequency, and incontinence
• At-home treatment options
• Other free resources