Basic Facts Incontinence is any involuntary loss of urine, which often is associated with an underlying medical condition. One-third of people over the age of sixty have some loss of urinary control. Most incontinence is caused by genetics and lifestyle factors, such as obesity, smoking, and childbirth.

The female genitourinary tract.

Incontinence—the involuntary release of urine—is a medical condition that is well-known but rarely discussed. Because it can be socially embarrassing and isn’t life-threatening, many people with incontinence suffer in silence by not talking about the condition with their physicians. Their silence is unfortunate because there are treatments that can help.

Despite the secretiveness surrounding it, incontinence is anything but rare. Experts estimate that 35 to 50 million Americans, including children, have periods of occasional or frequent involuntary urine loss.

Perhaps due to the effects of childbirth on the pelvic muscles, women experience incontinence two times more often than men.

The male genitourinary tract.

Incontinence is not a natural consequence of growing older. It results from weakening of the pelvic muscles from childbirth or obesity, aging, which can reduce the size of the bladder as well as a variety of urinary area conditions, such as

• enlarged prostate,
• urinary tract infections,
• pelvic floor dysfunction, and
• damage to the nervous system.

THE ANATOMY BEHIND INCONTINENCE

Incontinence occurs when the normal function and or tissue surrounding the bladder and urethra breaks down. In simple terms, this breakdown can be mechanical, meaning a physical obstruction such as a urinary stone exists. Or, it may be electrical, meaning a person has experienced some form of nerve damage and the body isn’t clearly transmitting nerve signals.

How the bladder works when releasing urine.

Normally, once the bladder fills to capacity after receiving typically about 8 to 16 ounces of urine from the kidneys, stretch-sensitive nerves in the detrusor muscles of the bladder walls send a signal to the spinal cord and brain, triggering an urge to urinate. At this point, two ring-like muscular valves, an internal sphincter in the bladder neck and the external sphincter at the external outlet of the urethra, hold in urine flow. The internal urethral sphincter begins to relax only when the spinal cord receives the nerve signal that the bladder is full. Yet it is the brain that has final say, holding the external sphincter shut until a person can find a place to go the bathroom.

When incontinence occurs, some disturbance has interfered with this process. That disturbance can either be temporary and caused by passing infections, constipation, irritations, or medication use, or it may be chronic.

‘STRESS’ IS MOST COMMON INCONTINENCE

Technically, incontinence takes several forms: stress, urge, reflex, overflow, and functional.

Stress incontinence is the most common of these. It refers to when urine leaks following activities that temporarily increase the pressure within the abdomen, such exercise as well as sneezing, laughing, or coughing. Half of all women experience this problem at some time in their lives.

Anatomically, stress incontinence stems from a “fallen bladder," meaning the bladder, which normally sits high above the pelvic floor held in place by a triangular sheet of muscle, begins to sag from weakened pelvic muscles. In this position, the internal urethral sphincter on the neck of the bladder naturally squeezes shut when the abdominal feels pressure. However, because the internal sphincter can no longer close properly due to weakening muscles, the external sphincter takes over the entire job of holding in urine. Most of the time, the external sphincter manages to retain urine, but sudden pressure can cause it to temporarily lose its grip.

Stress incontinence.

Because men’s pelvic muscles are configured differently than women’s, they are less susceptible to fallen bladder. An exception to this advantage is when men undergo prostate surgery and commonly experience stress incontinence when their bladder muscles are damaged during the surgical removal of the prostate gland.

Other than this exception, stress incontinence most often affects women, particularly after childbirth. During childbirth, muscle fibers around the bladder can tear and never completely return to their original strength. Menopause can compound the problem by robbing the body of estrogen, a hormone that helps maintain muscle tone. In addition, time and gravity, both of which weigh heavily upon the abdominal organs, can weaken the pelvic floor muscles, a gravitational pull that worsens if women become obese.

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