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Urge incontinence is the inability to stop the flow of urine when the urge to urinate is felt. Although it is a condition most people do not care to discuss even with their doctors, urge incontinence is extremely common. Just in the United States:

• 8 to 10% of men have urge continence associated with prostate problems.
• 25% of college athletes experience urge incontinence on the playing field.
• 33% of women experience urge incontinence after menopause.
• 60% of residents of nursing homes suffer urge incontinence on a daily basis.

The average sufferer of urge incontinence waits six to nine years before seeing a doctor about the condition. In meantime, 35% of people with the condition experience skin rashes, 10% suffer urinary tract infections (which is the usual trigger for seeking medical help) and 1% suffer broken bones in falls due to holding the body in unusual positions while attempting to avoid urination.

Prolonged contact with urine breaks down the skin. Sores and ulcers allow the tissues under the skin, and sometimes the entire body, to be infected by various forms of hard-to-treat bacteria. Without effective treatment, urge incontinence can become a serious threat to life itself.

Before they seek a doctor's advice concerning urge incontinence treatments, sufferers of the condition develop a tremendous variety of coping strategies to avoid embarrassing situations:

• Adult diapers
• Avoiding drinking fluids for several hours before social interaction
• Avoiding social interaction
• Carrying spare clothing/underwear
• Double underpants
• Just-in-case trips to bathroom whenever possible
• Pads and panty liners
• Thicker trousers or jeans
• Tightening the pelvic floor to "hold it in"
• Wearing dark clothing

Men, in particular, often do not know that various kinds of absorbent pads and undergarments are available for them. And the first step in medical treatment of urge incontinence in both men and women is usually finding an appropriate absorbent pad.

Absorbent pads for men and women. Absorbent pads and undergarments are designed to trap urine and keep the wearer dry while minimizing odor. These products are designed to protect both skin and clothing. People with urge incontinence may choose among absorbent briefs, spill-proof underpants, pant liners (shields and guards), adult diapers, washable pants, disposable pad systems, or combinations of these products.

None of these products, however, is designed to capture more than about 1-1/4 cups (300 ml) of urine, and some capture much less. The greatest protection is offered by bulky pants liners that have to held in place by adhesive tape, waistbands, or tight underwear, while minimal protection (about 20 ml urine capture) is provided by urine guards and panty shields. When these products have captured their maximum amount of urine, they must be changed.

Urine caps. When absorbent pads are not enough, doctors prescribe urethral occlusive devices that are placed in the urethra itself to stop the flow of urine. They have to be removed and replaced every time the user urinates, and there is a constant risk of bladder infection. Also, urine caps can fall off between scheduled uses and result in accidental voiding.

Catheters. When absorbent pads and urethral occlusive devices are not enough, doctors usually recommend the placement of a catheter, a thin tube inserted through the urethra to the bladder to conduct urine to a plastic bag for collection. The bag is emptied into the commode several times a day, and the catheter itself is replaced in the doctor's office about once a month. The catheter tub and collection bag can be tied to one leg so that they are not noticeable under clothing.

Catheters sometimes allow the bladder to heal so that it returns to its normal capacity and sensitivity. Elderly people who might "forget" they have a catheter, however, and try to remove it—a sad situation that many families have to deal with—are at extra risk for potentially deadly bladder infections. Even for these persons, a catheter may be the best of several bad alternatives.

Fortunately, there are many urge incontinence treatments that can be done at home that may keep the problem manageable. Diet is a good place to start. Certain foods should be avoided when there is urge incontinence:

• Hot spices, such as curry, chili peppers, and mustard, increase the urge to urinate. Avoiding these foods reduces urge incontinence.
• Acidic foods, especially citrus fruits, increase the urge to urinate. Avoid oranges, grapefruits, and especially lemons and limes, and their juices.
• Chocolate and caffeine together are a potent stimulant to urination. Excessive consumption of chocolate can cause irritable bladder, which is characterized by unpredictable urination.

Fluid management also helps:

• At least 6 to 8 glasses of fluid every day is still essential even when there is urge incontinence. Drinking water is essential to prevent dehydration, urinary tract infections, and kidney stones.
• Drinking more than 8 glasses of water a day, however, makes management of urination difficult.
• Caffeinated beverages of all kinds, coffee, tea, colas, and hot chocolate, should be avoided. If coffee is desired, choose decaf or instant coffee. Instant coffee has less caffeine that percolated coffee or drip coffee.
• Avoid citrus juices and carbonated drinks, both of which stimulate urination.

And, for nighttime symptoms:

• Avoid drinking fluids after dinnertime.
• People who have congestive heart failure sometimes have a problem with nighttime urination because lying down returns fluids to the heart, which pumps them to the kidneys. Wearing support stockings during the day can prevent the accumulation of fluids that have to be eliminated at night.
• If you take a diuretic, take it in the morning, not the evening.

Kegel exercises are often recommended as a preferred form or urge incontinence treatment, but they are not really useful for people who have difficulty controlling the sphincter muscles that hold urine in. Kegel exercises are most useful for younger women who have urge incontinence that is worst during stress, or after drinking carbonated beverages or eating spicy foods.

Kegels are best done immediately after voiding. To perform the exercise, simply practice "holding it in," clinching the muscles of the pelvic floor for 15 to 20 seconds up to 25 times a day. Be sure to "take a day off" from Kegel exercises at least 3 days a week to allow the muscle fibers to repair themselves so that they can create a stronger muscle.