What is urge incontinence?

Urge incontinence is a sudden, intense urge to urinate paired with involuntary urine leakage. Unlike stress urinary incontinence, which is largely driven by poor intraabdominal pressure management, urge incontinence is caused by involuntary bladder muscle (detrusor) spasms that override the ability to hold urine until in the restroom.

What causes urge incontinence?

There are multiple potential causes of urge incontinence:

• Bladder muscle overactivity (detrusor overactivity)- When the detrusor muscles contracts too soon and too often, even if the bladder isn’t full, this results in the urgent need to urinate. Unlike pelvic floor muscles, which are skeletal muscles and under our control, the detrusor muscle is a smooth muscle, like our heart muscle. This means that the bladder muscle is not under our voluntary control. If detrusor overactivity is causing your urge incontinence, your primary care physician can help with pharmacological interventions.
• Poor pelvic floor and nervous system coordination- To maintain continence, the pelvic floor and bladder work together. When the pelvic floor is contracted and the bladder is released, urine is stored, and no leakage occurs. When pelvic floor muscles relax and the bladder contracts, you’re able to void. During episodes of urge incontinence, this teamwork is disrupted. Disruption can occur with or without underlying conditions, like MS, Parkinson’s, or diabetes.
• Bladder irritants and dietary triggers- Foods and beverages containing caffeine, alcohol, high acidic content, artificial sweeteners, and spice can irritate the bladder, and worsen urge incontinence.
• Weak and/or overactive pelvic floor muscles- To keep us continent, pelvic floor muscles need to be able to relax and contract. If the pelvic floor muscles are weak, they might not be able fully contract and counteract bladder spasms, leading to leakage. If the pelvic floor muscles are too tight, it can further irritate the bladder and contribute to hypersensitivity. In addition, overactivity prevents full contraction, making the pelvic floor inefficient at countering bladder contractions.
• Hormonal changes (menopause and aging)- Estrogen loss can impair muscle and tissue integrity, making the bladder more reactive, and the pelvic floor muscles less able to function properly.
• Just-in-case (JIC) urination- JIC-ing, or going to the bathroom without a strong urge to urinate “just-in-case” you might need to use the restroom later at a less convenient time, can increase brain sensitivity to bladder signals, leading to a heightened sense of urgency.

How can pelvic floor physical therapy help me?

Pelvic floor physical therapy interventions to treat urinary urgency include:

• Urge suppression strategies
• Timed voiding
• Deep breathing techniques
• Pelvic floor muscle training
• Core strengthening
• Manual therapy and nerve desensitization
• Lifestyle interventions