Urge Urinary Incontinence and Overactive Bladder

Urge urinary incontinence is urine leakage that occurs with urgency or the strong desire to urinate. This type of incontinence is common and occurs more often as women age. In addition women with diabetes or other chronic conditions which cause nerve damage are at higher risk of urge incontinence.


Bladder Training

Bladder training is a simple, low risk treatment for urge incontinence. It starts with completing a bladder diary (Link to our bladder diary under forms)

Then your physician will make a personalized voiding schedule. After following this schedule for several months, more than half of women will see significant improvement in their incontinence.

Diet and Lifestyle Modification

Though this is an understudied area, many women find that decreasing caffeine intake, stress reduction and other changes help with urinary urges and urge incontinence. 

Complimentary and Alternative Medicine

Recently a trial of hypnotherapy demonstrated excellent improvement and was similar in effectiveness to medications at one year.


Medications can be helpful for managing urinary urgency incontinence. Medications may be used together with other treatments. Anticholinergic medications may cause issues when taken long term, so we commonly use these medications to gain control of the issue while working on other therapies for long term improvement.


Two types of neuromodulation are approved to treat urgency urinary incontinence:

Posterior tibial nerve stimulation: Posterior tibial nerve stimulation uses a gentle electrical pulse to simulate the spinal roots that control the bladder. An acupuncture needle is placed at the ankle and stimulation is performed for 30 minutes once per week for 12 weeks. This has an excellent safety profile.

Sacral nerve stimulation: In this procedure a permanent lead is placed through the S3 sacral foramina to stimulate the nerves that control the bladder. Patients keep a diary of their improvement for two weeks and if they have a 50% decrease in incontinence or frequency episodes, a battery is implanted.


In this short office procedure, the bladder is numbed and then Botox or Onabotulinum Toxin A is injected into the bladder through a cystoscope. This procedure must be repeated every 6- 12 months.


Rarely, if none of the above treatments work, surgery such as clam cystoplasty may be done to increase the amount of liquid the bladder can hold.