Incontinence is defined as the involuntary leakage
of urine from the bladder. Incontinence can affect both men and women
in any age group but is more common in women and the elderly. As the
population ages, the number of people suffering bladder control problems
is increasing. The costs of this problem are personal, physical and
financial , and many with incontinence suffer social embarrassment,
isolation, ill health and even depression.
Normal urinary continence and bladder control requires a complex
interaction between the brain, nervous system and organs in the pelvis.
The pelvic organs include the bladder, urethra, the prostate in men,
and the muscles of the pelvic floor called the levator ani. Controlling
the outflow of urine are two valves, or sphincters, located in the
bladder neck and earliest portion of the urethra. The bladder neck
sphincter is under involuntary (autonomic) control while the urethral
sphincter has both voluntary and involuntary components. The levator
ani muscles act as a supporting hammock for this system and also have
reflex as well as voluntary activity.
The bladder has two essential functions, to store urine and to empty
urine. While this concept is simple, the interplay necessary between
the brain, bladder, sphincters and pelvic floor muscles is very complex.
Perceptions of bladder filling and fullness, and subsequent initiation
of emptying requires synchronization of the nervous system, the bladder
muscle, sphincters and pelvic floor. Similarly, controlling a full
bladder in the face of daily activity relies on precise neural orchestration
and healthy pelvic organs.
When any component of the system loses normal function, urinary control
can be affected. Neural injury, damage to the bladder, sphincters,
supporting structures and even the pelvic floor can all lead to incontinence.
It is important to understand that treatment is available. Incontinence
is not something to accept as a result of age, surgery, childbirth,
or related illness. Our understanding of the mechanisms of urine leakage
and therapies to restore control continues to progress. The first
step towards treatment, however, is recognition of the problem. Incontinence
is a burden that can be lifted.