Incontinence

Incontinence is seen more frequently among the elderly. Women are more likely than men to be affected by urinary incontinence.

Incontinence is not a hopeless situation. Although incontinence is usually not an emergency, problems with incontinence should be reported to the doctor. The gynecologist and the urologist are the specialists who are most familiar with incontinence and can evaluate the causes of incontinence and recommend several treatment approaches.

NORMAL URINATION:

The ability to hold urine and maintain continence is dependent on normal anatomy and function of the lower urinary tract and the nervous system. Additionally, the person must possess the physical and psychological ability to recognize and appropriately respond to the urge to urinate.

The process of urination involves two phases: 1) the filling and storage phase, and 2) the emptying phase. Normally during the filling and storage phase, the bladder begins to fill with urine from the kidneys. The bladder stretches to accommodate the increasing amounts of urine. The first sensation of the urge to urinate occurs when approximately 200 ml of urine is stored. The healthy nervous system will respond to this stretching sensation by alerting you to the urge to urinate while also allowing the bladder to continue to fill. The average person can hold approximately 350 to 550 ml of urine. The ability to fill and store urine properly requires a functional sphincter (the circular muscles around the opening of the bladder) and a stable bladder wall muscle (detrusor).

The emptying phase requires the ability of the detrusor muscle to appropriately contract to force urine out of the bladder. Additionally, the body must also be able to simultaneously relax the sphincter to allow the urine to pass out of the body.

Urinary control relies on the finely coordinated activities of the smooth muscle tissue of the urethra and bladder, skeletal muscle, voluntary inhibition, and the autonomic nervous system.

Incontinence can result from anatomic, physiologic, or pathologic (disease) factors. Congenital and acquired disorders of muscle innovation (e.g., ALS, spina bifida, multiple sclerosis) eventually cause inadequate urinary storage or control.

Acute and temporary incontinence are
commonly caused by the following:

Childbirth
Limited mobility
Medication side effect
Urinary tract infection

Chronic incontinence is commonly caused by these factors:

Birth defects
Bladder muscle weakness
Blocked urethra (due to benign prostate hyperplasia, tumor, etc.)
Brain or spinal cord injury
Nerve disorders
Pelvic floor muscle weakness

Types:

Of the several types of urinary incontinence, stress, urge, and mixed incontinence account for more than 90% of cases. Overflow incontinence is more common in people with disorders that affect the nerve supply originating in the upper portion of the spinal cord and older men with benign prostate hyperplasia (BPH). The primary characteristics of these types are as follows:

Stress—urine loss during physical activity that increases abdominal pressure (e.g., coughing, sneezing, laughing)
Urge—urine loss with urgent need to void and involuntary bladder contraction (also called detrusor instability)
Mixed—both stress and urge incontinence
Overflow—constant dribbling of urine; bladder never completely empties
Incidence and Prevalence

The U.S. Department of Health and Human Services reported in 1996 that approximately 13 million people in the United States suffer from urinary incontinence. The condition is far more prevalent in women than men. In the general population aged 15 to 64 years old, 10-30% of women versus 1.5-5% of men are affected. At least 50% of nursing home residents are affected. Of that number, 70% are women.