A 72-year-old female describes sudden leakage of urine with a strong urge, along with daytime frequency and nocturia. What is the most likely diagnosis?

• A. Overflow incontinence
• B. Urge incontinence
• C. Functional incontinence
• D. Stress incontinence

Answer: (B)

Urge incontinence occurs when there is a sudden, compelling urge to void that leads to leakage. The pattern described—sudden leakage with a strong urge, along with daytime frequency and nocturia—fits this type best. It reflects detrusor overactivity, where the bladder muscle contracts involuntarily during filling, causing leakage before the person can reach the toilet. This is common in older adults and can be associated with an overactive bladder syndrome.

Understanding how this differs helps: overflow incontinence typically presents with dribbling and a weak, hesitant stream due to incomplete emptying; stress incontinence leaks with activities that raise abdominal pressure (coughing, sneezing, lifting) and is not driven by an abrupt urge; functional incontinence arises from functional limitations (mobility, cognition) rather than a bladder contractile problem. So the sudden leakage with urgency and frequency points to detrusor overactivity and urge incontinence. Treatments focus on bladder training, pelvic floor exercises, and medications that reduce involuntary detrusor contractions, such as antimuscarinics or beta-3 agonists, tailored to the patient’s tolerance and comorbidities.