Urge incontinence

Overactive bladder; Detrusor instability; Detrusor hyperreflexia; Irritable bladder; Spasmodic bladder; Unstable bladder; Incontinence - urge; Bladder spasms

• Frequent urination, in the daytime and at night
• Involuntary loss of urine
• Sudden and urgent need to urinate (urinary urgency)

During a physical examination, the health care provider will look at the abdomen and rectum. Women will also have a pelvic exam. Men will also have a genital exam. In most cases the physical exam reveals nothing abnormal.

If there are nervous system (neurologic) causes, other abnormalities may be found.

Tests include the following:

• EMG (myogram) - rarely needed
• Inspection of the inside of the bladder (cystoscopy)
• Pad test (after placement of a previously weighed sanitary pad, the patient exercises, then the pad is weighed to determine urine loss)
• Pelvic or abdominal ultrasound
• Post-void residual volume (PVR) to measure amount of urine left after urination
• Urinalysis or urine culture to rule out urinary tract infection
• Urinary stress test (the patient stands with a full bladder and coughs)
• Urodynamic studies (measurement of pressure and urine flow)
• X-rays with contrast dye

Further tests will be performed to rule out other types of incontinence. The "Q-tip test" measures the change in the angle of the urethra at rest and when straining. An angle change of greater than 30 degrees often is a sign that the muscles supporting the bladder are weak. This is common in stress incontinence.