Illness script
Urge Incontinence
Sudden strong urge to void followed by involuntary urine leakage, often with frequency and nocturia.
This illness script for Urge Incontinence covers the classic presentation, who it affects, how you work it up, the mechanism, and first-line treatment—written for USMLE Step 1 and clerkship clinical reasoning.
Updated Jul 18, 2026All scripts
01
Who it affects
- Older adults, more common in women
- Prevalence increases with age
- Risk factors: neurologic disease (stroke, MS, Parkinson), diabetes
- Bladder irritants: caffeine, alcohol; UTI can trigger
- Overactive bladder syndrome overlap
02
Diagnostics & workup
- History: urgency, frequency, nocturia, leakage with urge
- Exam: pelvic/rectal exam, neuro exam
- Urinalysis to exclude infection, hematuria
- Post-void residual to exclude retention/overflow
- Bladder diary to quantify symptoms
- Urodynamics (gold standard) if refractory — detrusor overactivity
03
Pathophysiology
- Involuntary detrusor muscle contractions during filling
- Detrusor overactivity — increased sensory/motor bladder signaling
- May be neurogenic (loss of central inhibition) or idiopathic
- Contrast with stress incontinence (sphincter/urethral weakness)
04
Treatment
- First-line: behavioral therapy, bladder training, timed voiding
- Pelvic floor exercises, fluid/caffeine reduction, weight loss
- Antimuscarinics: oxybutynin, tolterodine, solifenacin
- Beta-3 agonist: mirabegron (fewer anticholinergic effects)
- Refractory: intravesical botulinum toxin, sacral neuromodulation, PTNS
- Treat reversible causes (UTI, medications)
Keep reading
Full library- TrichomoniasisSexually active woman with frothy, malodorous yellow-green discharge and a 'strawberry cervix'.
- Uterine Leiomyoma (Fibroids)Reproductive-age woman with heavy menstrual bleeding, pelvic pressure, and an enlarged, irregular, firm uterus.
Educational use only. This illness script is a study framework, not medical advice. Confirm decisions with current guidelines and your clinical supervisors.