INCONTINENCE DUE TO OVERACTIVE BLADDER: URGENCY
formerly known as urge incontinence
Urgency, characterized by a sudden and compelling need to urinate, is a key symptom of overactive bladder. It corresponds to involuntary bladder contractions that can occur even when the bladder is not completely full.
Symptoms and Diagnosis of Overactive Bladder
Urgency may occur with or without urine leakage, accompanied by an increased number of urinations per day (more than 7), known as pollakiuria, and frequent nighttime urination due to the urge to urinate, called nocturia (more than 2).
These various symptoms may be secondary to an underlying condition (examples: bladder tumor, bacterial cystitis, radiation cystitis, stones, neurological disease…) which should be ruled out before considering any treatment.
Management of Recurrent Urinary Tract Infections
Recurrent urinary tract infections are common in patients suffering from urgency. It is recommended that these patients have urine test strips at home for quick diagnosis. If the test strip indicates an infection, a complete urine analysis should be performed in a laboratory to allow for appropriate antibiotic selection, thus avoiding the development of bacterial resistance.
Underlying Causes of Urgency
The causes of urgency are not well understood; however, aging with bladder mucosa abnormalities, menopause with estrogen decline, metabolic disorders (abdominal obesity, hypertension, elevated fasting blood sugar, cholesterol…), and alteration of the bladder microbiome (imbalance in lactobacilli) are considered factors.
Rehabilitation Techniques
Rehabilitation techniques include electrostimulation in a clinic with a therapist to apply specific stimulation that calms the bladder, but this technique can also be offered at home if the patient responds well to treatment, helping to maintain results. These devices are covered by the primary health insurance fund, either through a three-month rental or purchase. They must be prescribed by a urologist.
This technique can be complemented by biofeedback: the patient performs a long, gentle pelvic floor contraction guided by the therapist, which she can visualize on a screen to better analyze her movement and trigger a reflex that calms the bladder (Mahony’s reflex 3).
Behavioral Approaches
The behavioral technique involves keeping a voiding diary where the patient records volumes and times of each urination over 3 days (3 times 24 hours), her fluid intake, and the quality of beverages consumed.
The therapist will analyze the diary and provide behavioral advice, for example, not going to the bathroom if there is no urge, avoiding bladder-irritating drinks such as tea, coffee, white wine, and champagne.
Medication and Surgical Options
There are medications that can help calm the bladder, such as anticholinergics, but they are used cautiously in elderly patients due to the risk of cognitive side effects. Another medication on the market without this drawback is mirabegron, sold under the name Betmiga®, but it has not received marketing authorization and therefore is not reimbursed.
Local treatment with estrogen can be proposed. (Consult an oncologist if the patient has or had hormone-dependent breast cancer).
Probiotics may also be offered to recolonize the bladder through intestinal rebalancing.
Surgical techniques include botulinum toxin injections to paralyze the bladder muscle, and the implantation of a permanent stimulator may also be proposed.
Therapeutic Education
Therapeutic education advice will be offered to the patient to improve her metabolism: combating constipation with recommended defecation posture, sufficient fluid intake, balanced diet with soluble and insoluble fiber, proper abdominal costodiaphragmatic breathing, and abdominal massage.
Physical activity is recommended, and if overweight is present, a diet will be advised.
