Urge  incontinence, or bladder instability, is an extremely common form of incontinence affecting both children and adults. In many children, it may be severe enough to bring about some bedwetting also. Some girls may also complain that their wetting is more prominent at the beginning of their period. 

Patients will complain of having to void urgently and leaking because of inability to get to the bathroom on time. They may also complain of frequency and suprapubic pressure. Usually, the urine is sterile; but this condition will often predispose to recurrent urinary tract infections in girls. 

Adults may develop the condition spontaneously, or it may occur after prostate surgery in men or bladder neck suspension in women. Various other problems may cause urge incontinence in either men or women. These include stroke, Parkinsonism, brain surgery, etc. Associated back pain, sciatica, headaches, thirst problems or bowel problems in conjunction with urinary incontinence also demand additional neurological evaluation, probably with the aid of MRI studies. 

Treatment of this condition relies on pharmacologic agents suppressing the bladder muscle (detrusor) spasms and hyperreflexia.

Various medications are employed, but usually initial treatment centers on one of several anticholinergic medications to suppress uninhibited bladder contractions. Examples of the anticholinergics are Ditropan, Pro-Banthine, Robinul, Detrol, Levbid and Cystospaz. 

An example of a tricyclic antidepressant that has a significant effect on uninhibited bladder contractions and also has an effect on bedwetting is Imipramine (Tofranil). 

A musculotropic relaxant that depresses smooth muscle activity directly rather than affecting the cholinesterase mechanism is Urispas. 

Some medications have a mixture of useful agents, such as Urised and Prosed. 

If a behavioral or pharmacalogical approach isn’t effective in controlling urinary urge incontinence, or nonobstructive urinary retention, then a reversible treatment called The InterStim Therapy, where a neurostimulator, lead and extension are implanted to electrically stimulate the sacral nerve that controls the voiding function, may be considered. (See InterStim Therapy.) Adverse events that may occur include pain, lead migration, and infection. 

Stress Urinary Incontinence 

This is usually due to weakness in the pelvic floor and bladder support mechanisms and is often related to vaginal deliveries. Pelvic muscle exercises after delivery may help in lessening urine loss after exercise. They are called Kegel exercises and can be done lying down after the bladder is emptied. With the knees slightly bent, you can focus on drawing the muscles about the vagina together as if trying to stop the urinary flow. Try holding this contraction for at least 10 seconds and then relaxing for 15 seconds. A series of these contractions can be done on alternate days, and benefits can be seen after several months. 

Treatment options for stress incontinence are numerous, from non-surgical such as Kegel exercises, biofeedback techniques, medications and vaginal pessary to surgical procedures that range from endoscopic to vaginal or suprapubic.

Endoscopic collagen or endoscopic Teflon injections into the urethra act as a bulking agent and may be useful to increase bladder outlet resistance in those with relatively minor stress incontinence problems.

 The suprapubic approach is common as either the Marshall-Marchetti-Krantz (MMK) retropubic suspension procedure or as the Burch, in which the anterior vaginal wall is fixed to Cooper's ligament. Both these procedures are performed through a small "bikini" incision.

The vaginal approaches, however, have been modified and have become the most popular. Both Stamey and Raz have popularized variations of suprapubic needle passage into the vagina for bladder neck suspension. 

Currently, the most popular procedures utilize some sort of sling to elevate the bladder neck area. A technique that involves mobilizing an island of anterior vaginal wall and using it to support the bladder neck area has been found to have a high initial success rate. (See SPARC Urethral Support Sling.) Similar procedures have been developed using autologous or cadaver tissue; long-term results are not available yet. 

Male Stress Incontinence 

Men may experience stress urinary incontinence after prostate surgery. After the appropriate evaluations,it too may be treated with medications, Kegel exercises, endoscopic collagen or surgery as in placement of an incontinence sphincter or as in the placement of a sling such as the In-Vance sling procedure. (See InVance Sling for more information.)

Overflow Incontinence 

This type of incontinence is leakage from a bladder that fails to empty properly and may be the result of severe bladder or urethral obstruction, a neurologic lesion or diabetes. 

Congenital Incontinence 

This form of leakage is found in children with congenital anomalies. Examples include ectopic ureters, either in a duplicate or single system, and epispadias/exstrophy.

Giggle Incontinence 

This form of leakage occurs when the patient giggles or laughs. The reason for this type of incontinence is unknown but appears to respond nicely to Ritalin, 5 mg po tid. 

Neurogenic Incontinence 

The type of leakage varies, depending on the type of nerve lesion and the level of the nerve lesion. It is common in children with spina bifida and may worsen in those with a tethered cord. 

Traumatic Incontinence 

This can be seen after a fractured pelvis or after surgical damage to the bladder neck, prostate or sphincter. Erosion of an artificial sphincter previously placed to bring about continence may also result in incontinence once more.