Urgency is a symptom where you have a sudden urgent desire to pass urine. You are not able to put off going to the toilet. Urge incontinence is the term used for when urine leaks before you get to the toilet when you have urgency.
Urgency and urge incontinence are often symptoms of an unstable or overactive bladder, also known as detrusor instability. (The detrusor muscle is the medical name for the bladder muscle.)
If you have urgency or urge incontinence, you also tend to pass urine more often than normal (this is called frequency). Sometimes this is several times during the night as well as many times during the day. Some women also find that they leak urine during sex, especially during orgasm.
Your doctor or nurse may ask you to keep a chart to record the times you pass urine, the amount of urine you pass on each occasion, and the times you leak urine (are incontinent).
Urge incontinence is the second most common cause of incontinence. About 3 in 10 cases of incontinence are due to urge incontinence. It can occur at any age but commonly first starts in early adult life. Women are more commonly affected than men.
In this condition, the bladder muscle (detrusor) seems to become overactive and squeeze (contract) when you don't want it to.
Normally, the bladder muscle is relaxed as the bladder gradually fills up. When the bladder is about half full, you start to get a feeling of wanting to pass urine. In people with overactive bladder and urge incontinence, the bladder muscle seems to give the message to the brain that the bladder is fuller than it actually is. This results in the bladder contracting too early, giving you the feeling that you have to pass urine urgently.
In most people, the reason why an overactive bladder develops is not known. In such cases, the condition is called overactive bladder syndrome or idiopathic urge incontinence. Symptoms may get worse at times of stress. They may also be made worse by caffeine (in tea, coffee, cola, etc) and by alcohol. See the separate leaflet called Overactive Bladder Syndrome (OAB).
Some women develop urge incontinence after the menopause and this is thought to be due to the lining of the vagina shrinking (vaginal atrophy) due to a drop in the level of the female hormone oestrogen.
In some cases, symptoms of an overactive bladder develop as a complication of a nerve- or brain-related disease. Examples are following a stroke or spinal cord damage, or with illnesses such as Parkinson's disease or multiple sclerosis (MS). Similar symptoms may occur if there is irritation in the bladder. Bladder irritation can occur when you have a urinary tract infection (UTI) or stones in your bladder.
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- Some general lifestyle measures which may help.
- Bladder retraining, which is a common treatment. This can work well in up to half of cases.
- Medication. This may be advised in addition to bladder retraining.
- Pelvic floor exercises. These may also be advised in some cases.
- Surgery. This is a last resort and rarely used to treat urge incontinence.
Dr Sarah Jarvis, April 2019
The National Institute for Health and Care Excellence (NICE) has published new guidelines on the management of incontinence and prolapse in women.
Their recommendations include:
- Women taking long-term medicine for treatment of overactive bladder should have their medication reviewed at least once a year. If they are over 75, their medication should be reviewed every six months.
- Doctors should take into account the fact that anticholinergic medicines for treating overactive bladder can have an effect on mental function, particularly in women with dementia.
- Treatment with botulinum toxin A should be considered for women whose overactive bladder symptoms have not improved with other non-surgical treatment, if they do not want to have other invasive treatments.
- Before botulinum toxin A treatment is given, women must be informed that there is little evidence about how long the injections work for, how well they work in the long term and their long-term risks.
- Women should be advised that botulinum toxin A treatment carries a risk that she will need to have a temporary catheter or catheterise herself regularly.
- Percutaneous sacral nerve stimulation can be considered if medication and botulinum toxin A have not worked or are not suitable.
You can find out more about the recommendations from NICE in our further reading section at the end of this leaflet.
If your urge incontinence is related to thinning of the lining of the vagina after the menopause, you may benefit from oestrogen cream applied directly inside the vagina. There is some evidence that oestrogen tablets can make urge incontinence worse; however, more research needs to be done on this.
Further reading and references
Urinary incontinence and pelvic organ prolapse in women: management; NICE guideline (April 2019)
Chapple CR, Wein AJ, Abrams P, et al; Lower urinary tract symptoms revisited: a broader clinical perspective. Eur Urol. 2008 Sep54(3):563-9. doi: 10.1016/j.eururo.2008.03.109. Epub 2008 Apr 8.
Urinary tract infection (lower) - women; NICE CKS, July 2015 (UK access only)
Uncomplicated urinary tract infection in women; Royal College of General Practitioners/Public Health England (January 2017)