Urgency Incontinence: Is It Interstitial Cystitis or Overactive Bladder?

Acute urge incontinence

Hello, doctor! I have been troubled by urgent urinary incontinence for four to five years.
I have previously consulted various hospitals' urology and gynecology departments, tried medications, used a magnetic chair, performed Kegel exercises, and received Botox injections twice, among other treatments, but none have been effective.
Some doctors diagnosed me with interstitial cystitis (IC), but I generally do not have nocturia; I might wake up occasionally to urinate.
When I asked other doctors, they said it is not interstitial cystitis.
My symptoms include a sudden urge to urinate that I cannot control, leading to a significant loss of urine.
Sometimes I can hold it, but I experience a feeling of pressure and pain at the urethral opening.
I can usually hold it for 2 to 3 minutes.
Urination itself is not painful, and I have had urine tests at the hospital that showed no issues.
Could this be classified as interstitial cystitis, or is it purely overactive bladder?

101, 50~59 year old female. Ask Date: 2020/09/27

Dr. Xu Wencang reply Urology

Interstitial cystitis should present with bladder pain and nocturia.
In cases of overactive bladder that persist and are unresponsive to medication, intravesical botulinum toxin injection may be considered.

Reply Date: 2020/09/27

More Info

Understanding the distinction between interstitial cystitis (IC) and overactive bladder (OAB) is crucial for effective management of urinary symptoms, particularly in cases of urgency incontinence. Your experience of sudden urges to urinate that are difficult to control, along with the sensation of pressure or pain at the urethral opening, raises important questions about the underlying condition.

Interstitial Cystitis vs. Overactive Bladder
1. Interstitial Cystitis (IC): This is a chronic condition characterized by bladder pain, pressure, and discomfort, often accompanied by increased urinary frequency and urgency. Patients with IC may experience pain during bladder filling and relief upon urination. However, the hallmark of IC is the presence of bladder pain, which is not typically present in OAB. IC can also lead to nocturia (waking at night to urinate), but you mentioned that this is not a significant issue for you.

2. Overactive Bladder (OAB): OAB is defined by a combination of urinary urgency, often accompanied by increased frequency of urination and, in some cases, urgency incontinence. It does not necessarily involve pain or discomfort in the bladder area. The key symptom is the overwhelming urge to urinate, which can lead to involuntary leakage of urine.

Given your symptoms—sudden urges to urinate, difficulty holding it, and the absence of pain during urination—it seems more likely that you are experiencing OAB rather than IC. The fact that you do not have significant nocturia and that your urine tests have come back normal further supports this distinction.

Diagnosis and Management
Diagnosing OAB or IC can be challenging, as symptoms often overlap. A thorough evaluation typically includes:
- Symptom Assessment: Keeping a bladder diary can help track the frequency of urination, urgency episodes, and any associated symptoms.

- Urodynamic Testing: This may be recommended to assess bladder function and rule out other conditions.

- Cystoscopy: In some cases, a cystoscopy may be performed to visually inspect the bladder and rule out other potential issues.

Treatment options for OAB often include lifestyle modifications, bladder training, pelvic floor exercises (like Kegel exercises), and medications such as anticholinergics or beta-3 adrenergic agonists. In some cases, neuromodulation therapies or Botox injections may be considered if conservative measures fail.

Conclusion
In summary, while your symptoms may initially suggest interstitial cystitis, the absence of bladder pain and the nature of your urgency point more towards overactive bladder. It is essential to work closely with your healthcare provider to explore these options and find the most effective treatment plan tailored to your specific needs. If you continue to have doubts about your diagnosis, seeking a second opinion from a specialist in urology or a pelvic floor dysfunction expert may provide further clarity and guidance.

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