Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
People who have bladder control problems have trouble stopping the flow of urine from the bladder. They are said to have urinary incontinence. Incontinence is uncontrollable leaking of urine from the bladder. Although urinary incontinence is a common problem, it is never normal.
Incontinence is both a health problem and a social problem.
Most people with incontinence suffer social
embarrassment. Many become depressed and limit their activities away from
home, often becoming socially isolated and lonely.
Physical conditions linked to incontinence include infection, skin irritations and infections, falls, fractures, and sleep disturbances.
Many people with incontinence are too embarrassed to
talk to their health-care provider about it. They "cope" or "just learn to
live with it." This is changing gradually as people realize that help is
Approximately 15%-30% of elderly people who live at home are affected by
urinary incontinence. Another 40% of elderly people who live in nursing homes are affected. Incontinence is a major reason for people going into nursing homes. However, it is not an inevitable consequence of aging.
Here is a brief description of the urinary system and the process of urination (micturition):
The urinary system is composed of the kidneys, ureters, bladder, and urethra.
The kidneys filter water and waste from the blood.
They excrete urine, which passes via the ureters to the bladder. The bladder
stores urine until you urinate.
The kidneys typically excrete about 1-1½ quarts
(1,000-1,500 mL) of urine in 24 hours.
The bladder is a hollow, muscular organ. The bladder wall includes a smooth muscle known as the detrusor muscle. The bladder's
size, shape, position, and relation to other organs vary with age and the
amount of urine stored.
The urethra is a narrow tube connecting the bladder
with the opening when the urine comes out of the body. Surrounding the urethra
are sphincter muscles, which partly control release of urine from the bladder
and from the body.
Although the bladder is able to hold about 600 mL of urine, the urge to urinate develops once the bladder contains 300 mL. As the bladder starts to stretch, nerves in the bladder and surrounding area send messages to the brain, via the spinal cord, telling
it that the bladder is filling. The brain sends back the urge to urinate.
Although you normally make the choice when to
urinate, once you decide to do so the nervous system takes over and the
process becomes automatic. The detrusor contracts and the sphincters relax to
allow urine to flow. When the bladder is empty, the sphincters contract and
the detrusor relaxes.
You can stop or hold off urination by contracting
(squeezing) the external sphincter, which causes relaxation of the detrusor.
Urine is stored, and the urge to urinate is temporarily stopped.
As you continue to produce urine, however, the messages to and from the brain get more urgent, and the urge to urinate becomes even stronger.
Urinary incontinence is believed to affect at least 13 million people in the United States.
That number may even be higher, and it is expected to
increase sharply with the aging of the baby boomers.
Incontinence affects both sexes and all ages but is
most common in older people.
Incontinence is much more common in women than in men. Most men with incontinence are older and suffer from some type of prostate disease.
The good news about urinary incontinence is that it is treatable. A
great majority of people with bladder control problems can be helped by
treatments that are available now. If incontinence cannot be cured, it can at
least be controlled.
In the practice of physical medicine and rehabilitation, voiding disorders are usually a result of neurologic conditions, such as spinal cord injury (SCI) or disease, cerebrovascular accident (CVA), traumatic brain injury (TBI), multiple sclerosis (MS), or dementia.