How Is Urge Incontinence (Overactive Bladder) Treated?

A fellow caregiver asked...

How is urge incontinence (overactive bladder) treated?

Expert Answer

Dr. Leslie Kernisan is the author of a popular blog and podcast at BetterHealthWhileAging.net. She is also a clinical instructor in the University of California, San Francisco, Division of Geriatrics.

Several approaches are used to treat urge incontinence (also called overactive bladder), which is the sudden and strong sensation of needing to use the bathroom, followed by a leakage of urine before this can happen. It's more common in older women, but many men are also affected.

First-line treatments:

Bladder training. Bladder training requires up to six weeks of dedicated effort but can be very effective. Not all doctors have the experience or time to coach patients through this method of learning to gradually gain better control over the bladder. One tactic is to try to develop a schedule for bathroom breaks and consciously delay urination until the set time. Gradually, the break times can be spaced farther apart. Biofeedback and electrical stimulation also are sometimes used to retrain the bladder.

Dietary changes. Controlling fluid intake and avoiding acidic foods (which are known to irritate the bladder) are especially useful with this type of incontinence. But withholding fluids is dangerous. and cutting back should be done carefully to avoid dehydration. Generally it's best to distribute fluid intake evenly throughout the day so the bladder isn't overtaxed at one time. People with urge incontinence should limit themselves to less than eight ounces of liquid per meal and should stop taking liquids two hours before bedtime. Minimizing constipation is also important.

Next-line treatments:

Medication. Several types can be used, especially bladder-relaxing agents (antimuscarinics). These include oxybutynin (Ditropan), tolterodine (Detrol), trospium (Sanctura), solifenacin (Vesicare), and darifenacin (Enablex). These drugs do work, but sometimes not as well as patients want them to, reducing incontinence episodes by 0.5 to 1 episodes per day; it's something, but not a miracle cure. They also carry often-noticeable side effects, mainly dry mouth and constipation. These drugs can be risky for the elderly, as they've also been linked to falls, blurry vision, and confusion.

Last-resort measures:

After other treatments have proven ineffective, the doctor may recommend high-tech nerve treatments such as sacral nerve stimulators, special botox injections (which can lead to a need for catheterization), and last-resort surgery to decrease bladder pressure and to increase bladder storage area by surgically relocating a section of bowel.