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 from 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 continue to progress. The first step toward treatment, however, is recognition of the problem. Incontinence is a burden that can be lifted.