Which history features suggest urge-predominant incontinence?

• A. Gradual leakage with exertion and pelvic floor weakness.
• B. Leakage only during physical activity and coughing.
• C. Sudden, intense urge with leakage and frequent urge symptoms, often with nocturnal symptoms.
• D. Only nighttime leakage without daytime urgency.

Answer: (C)

Urgence to void driving leakage is the hallmark of urge-predominant incontinence. When someone has a sudden, compelling urge to urinate that leads quickly to leakage, along with frequent urges during the day and often waking at night to void, this pattern fits detrusor overactivity underlying urge incontinence. It contrasts with leakage tied to physical activity or coughing, which points to stress incontinence from pelvic floor weakness, and with leakage only at night without daytime urgency, which suggests nocturnal enuresis or another nocturnal problem rather than urge-driven leakage. So, the history of a sudden, intense urge with leakage and frequent urge symptoms, often with nocturnal symptoms, best indicates urge-predominant incontinence.