Reader Question: I drink a lot of water and occasionally I have some terrible urgency in running to the bathroom. I just turned 60 and this has become more of a problem lately. My mother has so little control that she needs to wear pads all the time. I have heard that the exercise Kegels can help incontinence. Will they really help, and if so, how much and how often to see improvement?
Answer: Ah, urgency Probably the most common symptom people come to see me for. One doesn’t have to be incontinent to have urinary urgency, but many do. Urgency is the feeling of having to urinate with a strong sensation and the inability to prolong or put off voiding. There are many, many reasons for urinary urgency, and often we have no real explanation for the symptoms. It is important to be evaluated by a urologist in order to find out why you are having the symptoms and what are your options for treatment.
The most worrisome cause, but luckily the least common is cancer in the bladder. Often, small bladder lesions will first present with urinary urgency. This is why if you go to the urologist, you will often first get a workup for bladder cancer. Your urine should be checked for cancer cells, called a cytology, then you may have some kind of x-ray, like a Cat Scan or a kidney ultrasound. Lastly, the urologist will want to look in your bladder for any unusual lesions. This can be done in the office or the OR.
Urgency from other sources can be multi-factorial. As mentioned before, it is very important to get worked up completely. Some serious causes may include a neurologic problem like Multiple Sclerosis, stroke, or spinal cord injury. Often it may be that someone isn’t emptying his or her bladder well, so it is appropriate to have urgency because the bladder is full. Men may have urgency as a result of bladder hypertrophy from a big prostate. The bladder muscle gets a “work out” so to speak, in order to push the urine out through the big prostate. As a result, the bladder becomes overactive and can cause urinary urgency.
Women rarely have an obstruction to their bladder that would cause the bladder to become hypertrophied. Women however do have hormonal effects to their vaginal and therefore urethral tissues. After menopause, the lack of estrogen can change the character of the tissues and can cause or worsen urinary urgency. Recently, there has been a push for women not to take hormones because of a study showing an increased risk for breast cancer. In my practice, after examining a women, if I feel this may be a contributor to her symptoms, my patient and I have a frank conversation about the risks and benefits, and in the appropriate patient, I may prescribe topical estrogens.
Often, even after a full work up, I never find a good cause for urinary urgency. My work-up includes urodynamic testing, cystoscopy, urine testing, and a good physical exam. I have talked before about urodynamics, which is a test that measures the strength of the bladder muscle and also if it is overactive. If I find that someone has an overactive bladder causing urgency, I will often start medications called anti-cholinergics. There are five in this category. They all have pros and cons, and the specific differences are out of the scope of this blog. If one doesn’t work, I then will often try another one.
In your question, you asked about Kegel exercises. Traditionally, Kegels are exercises for Stress
incontinence, which is incontinence from a weak or mobile urethra and is completely different from urge incontinence. That being said, stress incontinence can sometimes cause urgency because some urine can drip into the top part of the urethra and cause the bladder to start contracting. Kegels may help some of the symptoms if that is why you are having them. There is also some evidence that contracting your pelvic floor can help arrest the sensation of urgency, but there is no clear evidence as to why. I say, do them, it can’t hurt, and if it helps, well, GREAT!! The best way to do them is to try to stop your urine stream several times while voiding. It can take weeks to months to see improvement. You should try to do them as much as possible. I usually tell people to do them at every stoplight while driving, during every commercial break, when standing in line, and any other time you remember to do them.