Urgency urinary incontinence

Urgency urinary incontinence is encompassed by the term overactive bladder.

Overactive bladder is usually defined as urinary urgency, accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of UTI or other pathology.

Urgency urinary incontinence is ref2242ed to as the involuntary loss of urine associated with urgency.

Characterized by unpredictable loss of urine.

Affects up to 19% of older women.

The vast majority of women with urgency urinary incontinence had no neurologic abnormality.

5-10% of women that urgency urinary incontinence at least monthly.

10-to 15% of women have overactive bladder.

Usually urinating 8 or more times in 24 hours is the threshold for classifying abnormal urinary voiding as overactive.

The number of voidings per day is up to 13 as the upper limit of normal in studies.

The number of voidings per day is associated with fluid intake.

Overactive bladder symptoms wax and wane and can resolve spontaneously over a period of one year in one in four cases.

For most women with urgency urinary incontinence symptoms are present for many years.

The association urgency urinary incontinence and destrusor overactivity on urodynamic testing is weak.

In general, women with urgency urinary incontinence have more symptoms than those with stress urinary incontinence because of the leakage is unexpected and may be of large volume.

Women with urge urinary incontinence have more quality of life issues, depression, sleep disorders, worsened sexual function, and less work productivity then matched control patients.

History should include urinary frequency, the presence of nocturia, the degree of urinary leakage, precipitating factors, voiding habits, and accessibility to a bathroom.

Coexistence of neurologic symptoms with urge urinary incontinence suggested ref2242al for neurologic evaluation.

Evaluation of the patient’s includes gross assessment of neurologic functions particularly those involving S2, S3 and S4 sacral nerves.

Measurement residual urine after voiding is indicated in women with symptoms of obstructive voiding.

Since bacteriuria can cause symptoms of overactive bladder initial evaluation includes urinalysis.

Voiding diary indicating the time of voidings, frequency of voiding, each incontinent episode, types and volumes of fluid intake is helpful.

Urodynamic testing is generally not required for the evaluation overactive bladder and urgency urinary incontinence as these are clinical diagnoses.

Obesity reduction resulted in a 70% decrease, or more, in the frequency of urgency incontinence episodes (Subak LL et al).

Higher caffeine intake is associated with the detrusor overactivity and decreasing caffeine may reduce the number of episodes(Arya LA et al, Bryant CM et al).

Bladder training, behavioral technique, teaching patients to urinate on the schedule, rather than responding to urinary urges.

Bladder training includes learning methods of distraction and relaxation, muscle pelvic floor strengthening, and such techniques improve urge incontinence outlooks, but few studies indicate significant differences (Wallace SA et al).

Kegel exercises to strengthen pelvic floor muscles is more effective than no treatment, placebo, or an active control treatments in women with stress and urgency urinary incontinence or alone (Dumoulin C).

Anti-cholinergic medications are the primary treatment.

A review of trials comparing treatments for urgency urinary incontinence showed that none of the six drugs evaluated was superior to another (Staskin D et al).

In a double-blind, double placebo-controlled, randomized trial involving women with idiopathic urgency urinary incontinence randomly assigned to daily oral anticholinergic medications vs intradetrusor onabotulinumtoxin A: were associated with similar reductions in the frequency of daily episodes of urgency urinary incontinence, and the group receiving onabotulinumtoxinA was less likely to have dry mouth and were more likely to have complete resolution of urgency urinary on continence, but higher rates of transient urinary retention and UTIs (Visco AG et al).

It is recommended that doing 3 sets of 15 contractions of Kegel exercises, held for 10 seconds each, per day(Hay-smith J).

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