Urinary Incontinence
Urinary incontinence is classified as the involuntary loss of urine. It has been estimated that it affects as many as 13 million Americans, 80 percent of whom are women. The worldwide prevalence of urinary incontinence is between 9 and 74%. The number of women with urinary incontinence of any type increases with age. Younger age group cohorts tend to reflect a lower percentage while post menopausal women tend to yield a higher percentage. Prevalence tends to be higher in women than in men due to anatomical differences as well as the fact that women experience pelvic trauma during childbirth.
In order to understand urinary incontinence, one must understand the anatomy and physiology of the urogenital system. Normal bladder control is maintained by the bladder and urinary sphincter as they work together as a valve. The urethra and urinary sphincter muscle relax and open, the bladder opens, and urine passes. The bladder neck and urethra are under muscular control with the lower portion of the sphincter tightening to maintain continence. When surrounding tissue is compromised or weakened, there is lack of bladder neck support and incontinence is the result.
The primary causes of urinary incontinence are:
- Bladder related: caused by the bladder's failure to store, failure to empty, or both; reduced capacity, involuntary contractions, poor bladder compliance.
- Sphincter related: poor positioning of the bladder neck in women, uncoordinated bladder sphincter action, sphincter damage or weakness, outlet obstruction.
There are three major types of incontinence which are based on the characteristics of the disorder:
- Stress: caused by weak external sphincter and pelvic floor muscles and an unsupported bladder neck.
- Urge: causes may be neurological in origin; bladder is overly sensitive and may contract unexpectedly.
- Overflow: continual leakage from an overly full bladder that never empties completely.
Pharmacologic therapy is generally used in the treatment of urge incontinence due to the fact that the underlying causes of urge incontinence are primarily related to neuromuscular dysfunction. Drugs used to treat urge incontinence include
anticholinergics, smooth muscle relaxants, calcium blockers, and antidepressants. These drugs, while effective, produce a variety of untoward side effects of varying degrees.
Stress incontinence is treated surgically, however anticholinergics found in common decongestants seem to be effective in patients with poor muscle tone and poorly
functioning sphincters. Estrogens, alpha-adrenergic agonists, phenylpropanolamine, and pseudoephedrine have had a positive impact.
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