I have urge incontinence. What are my non-surgical treatment options?

Troublesome bladders causing frequent toilet trips and urine leakage are sometimes viewed as par for the course if you’ve had children or have gone through the menopause, but incontinence occurs in people of any age. However, bladder problems are not inevitable, and there are many effective treatments available.

Whilst surgery is sometimes considered to treat incontinence, there are plenty of non-surgical treatment options for bladder issues, and doctors will usually recommend trying these options before considering surgery.

Incontinence is divided into two main categories: stress and urge. Stress incontinence is the involuntary leakage of urine when pressure in the abdomen increases, for example when you cough or sneeze. Urge incontinence is when you feel an urgent need to pass urine, and leakage occurs before you have the opportunity to access a toilet. Sometimes people can have elements of both stress and urge incontinence, which is called mixed incontinence.

Usually, urge incontinence and OAB are caused by problems with the detrusor muscle of the bladder wall

Urge incontinence is strongly linked to overactive bladder syndrome (OAB), which gives the same sensation of urgency and is associated with having to visit the toilet very often (frequency) and at night (nocturia). OAB can exist with or without leakage of urine. This article will explore how urge incontinence and OAB can be managed non-surgically.

Usually, urge incontinence and OAB are caused by problems with the detrusor muscle of the bladder wall. The detrusor muscle is in a relaxed state as the bladder fills, but as the bladder approaches the stage of needing emptying, receptors in the bladder muscle send a signal to your brain, conveying the sensation of needing to urinate. Unwanted leakage or incontinence occurs when the detrusor muscle contracts at times you don’t want it to.

One form of urge incontinence is detrusor overactivity, where the detrusor muscle contracts too early. Another form of urge incontinence occurs when the bladder does not stretch properly (known as poor detrusor compliance). This means that the pressure inside the bladder increases more quickly, which conveys a sensation of needing to urinate even though the bladder is not full.¹

Lifestyle modifications to help with incontinence

Detrusor overactivity has many causes. Those who have had previous bladder surgery can sometimes be left with detrusor muscle issues, and some neurological conditions such as a stroke or multiple sclerosis can cause urge incontinence.

However, the bulk of people with incontinence have no underlying sinister cause, and often some simple lifestyle adaptations can assist in controlling symptoms.²

Bladder training, also known as bladder drill, does take some commitment, but it can have a big effect on your symptoms

Firstly, caffeine can be a bladder irritant, and limiting your intake can have a calming effect on your OAB/urge incontinence. If you are drinking more than two caffeinated beverages a day, decrease your caffeine intake slowly over a few days to allow your body to get used to it.³ If you find that a decreased caffeine intake helps your symptoms but you miss your tea or coffee, look into decaffeinated versions.

Don’t forget that caffeine is also hidden in soft drinks such as cola and diet colas, green tea and energy drinks, as well as dark chocolate and some over-the-counter painkillers. Alcohol can have a similar irritant effect on the bladder, and trialling cutting down (or avoiding it entirely when you will not have easy access to a toilet) could help.⁴

Training your bladder to cope with visiting the toilet less often and being able to hold larger volumes of urine can also help. Bladder training, also known as bladder drill, does take some commitment, but it can have a big effect on your symptoms. It can be done with the guidance of a continence advisor or your GP. In many areas, patients can now directly self-refer to a continence clinic.

The general principle is to initially gauge how often you visit the toilet and the volume of urine you pass each time (measured with a jug). After your baseline is established, you should aim to extend the time between your toilet visits.

Performing regular daily pelvic floor exercises can help keep these muscles strong and is useful for all people who need them

As you begin to visit the toilet less frequently, you will pass a greater volume of urine with each toilet trip, and the sensation of urgency should improve. The eventual goal will vary between people, but passing urine 5-6 times per day is a good target to work towards.

The question of fluid intake is often raised when trying to manage OAB and urge incontinence, but UK guidelines state that fluid restriction is not advised⁵, while the NHS recommends drinking six to eight glasses of water per day.⁶ However, drinking much more than this – unless you are exercising or in a hot climate – could contribute to increased bladder urgency.

If you are troubled by waking at night to pass urine then you may want to look at ensuring you complete your daily fluid intake a couple of hours before bedtime.

Pelvic floor exercises are recommended for the treatment of stress incontinence, so if you have mixed incontinence this can help you manage your symptoms. If you struggle with symptoms of stress incontinence, your GP can refer you for a trial of supervised pelvic floor muscle training. However, it is currently unclear if these exercises have any role in alleviating OAB or urge incontinence.⁷

However, as a general rule, performing regular daily pelvic floor exercises can help keep these muscles strong and is useful for all people who need them, particularly those have been through or envisage that they may go through a pregnancy and childbirth.

Medical management

If the above measures do not adequately control your symptoms and you are interested in pursuing medication then do visit your GP. The most common medications used for OAB/urge incontinence are called anti-muscarinics. These medications work by relaxing the bladder muscle to give you some relief from the rapid frequency of toilet visits and sensation of urgency.⁸

The most common side effects of these classes of drugs are dry mouth, constipation, and dizziness. Generally, though, these unwanted effects lessen over time and starting on a low dose and titrating upwards makes them more tolerable, although this means you may not see an immediate effect.⁹

If the combination of lifestyle changes and medication has failed to control your symptoms, then you can discuss specialist referral with your GP

If you find the side effects intolerable or do not see any benefit within 4 weeks, your GP can prescribe you another anti-muscarinic drug, or consider other medications.¹⁰

For people who have been through the menopause, low oestrogen levels can cause thinning of the tissue in the vaginal area. This can sometimes lead to the feeling of urgency and bladder irritation as the openings of the bladder and the vagina are very closely located. In these circumstances, you may be offered an oestrogen cream to use in the area to help ease symptoms.¹¹

If the combination of lifestyle changes and medication has failed to control your symptoms adequately, then you can discuss specialist referral with your GP. Injections of botox into the bladder and nerve stimulation are not common management strategies, but may be required in some cases. Surgery is the last resort and rare for the management of OAB.

OAB and urge incontinence symptoms can significantly impact your quality of life. Some people may deliberately avoid public places and social events for fear of having a leakage accident, or not being able to get to the toilet on time.

If you are experiencing bladder issues, you don’t have to suffer alone: the medical profession recognises the impact bladder problems can have, and there are dedicated continence services available to offer support and advice.

Featured image is of three toilet rolls beginning to unravel against a pink background. The rolls are aligned so as to give an aesthetically-pleasing, asymmetrical effect

Last updated April 2023
Next update due 2026