Age Incontinence

The condition of involuntary leakage of urine is medically known as incontinence. This can be categorized into two types: urge incontinence and stress incontinence. Urge incontinence (which is also called "overactive bladder") typically occurs when the bladder sphincter muscles cannot contract powerfully enough to cut off the flow of urine and prevent leakage. On the other hand, stress incontinence is typically caused by a weakening of abdominal wall muscles, which leads to leaks when there's increased pressure on these weakened muscles from coughing, sneezing, or lifting heavy objects.

Incontinence has many effects on quality of life, including social isolation, anxiety, depression, and embarrassment.

The urinary tract consists of tubes, including the kidneys, ureters, bladder and urethra. Each of these tubes is lined with a particular layer of tissue called mucosa, which provides a thin layer of protection from harmful bacteria and other substances in the urine. The muscles that line these organs help control urination by relaxing or tightening to allow or stop urination. Nerves control these muscles in the spinal cord to which they are connected through spinal nerves. The nerves enter the spinal cord at different levels depending on how far they innervate the muscle they control.
One major part of incontinence is leakage due to weakness or malfunctioning of organs surrounding these muscles. This leakage could be due to a spinal cord injury or disease that causes nerve damage in some cases.

The primary muscle involved in the control of urination is called the bladder sphincter. The term "sphincter" comes from the Greek word for closing and refers to what this muscle does—it closes off the opening of the urinary tract. Another medical term that refers to it is "urothelium", which means "the first lining of an organ". The urethra, the tube connecting urine from inside the body with outside air, is also lined by a coating of specialized cells called "urothelial cells". This tissue is specifically essential in the urinary tract because it guards against infection by bacteria. In females, this tissue becomes important during childbirth when it helps to protect the babies from the mother's urine.
In females, stress incontinence is typically caused by weakened pelvic muscles and connective tissues that support the bladder, rectum and nearby organs. This can result from childbirth or ageing and may occur after an injury to the abdominal wall.

The following are predisposing factors for urge incontinence:

Stress incontinence occurs when a loss of bladder control results in leakage during physical activity or exertion. This can be due to the weakening of the muscles of the pelvic floor. The pelvic floor is made up of 3 different types of muscle:

Stress incontinence is a common condition and affects almost 5 million Canadians. It is often seen in women who have gone through childbirth and, in some cases, may lead to faecal incontinence – leakage of stool.

The most common form in women is stress urinary incontinence. This is associated with childbirth and ageing, and pelvic organ prolapse (POP) can lead to this particular form of incontinence—a herniation or weakening that causes the ligaments supporting the bladder, uterus or rectum to weaken. Women who have had vaginal births and are pushing a baby out can sometimes tear or strain their pelvic floor muscles.

In women, stress incontinence is associated with childbirth. The most vulnerable time for incontinence following birth is during the first year after delivery. Nearly three-quarters of women will experience some degree of urinary incontinence following childbirth, usually after delivery of the baby via caesarean section or forceps – which can cause severe pelvic floor trauma, especially to the bladder. In addition to the physical trauma caused by forceps deliveries and caesarean sections, medical interventions that are part of treatment may also play a role in the future development of urinary incontinence (e.g. hormone therapy used in the treatment of postpartum haemorrhage). Additionally, the number of vaginal deliveries is also a significant risk factor for stress urinary incontinence. The more vaginal deliveries (either regular or assisted), the greater the likelihood of later stress urinary incontinence. The amount of time it takes for women to recover from an episode of urinary incontinence also significantly increases the subsequent risk of having this condition. Women who do not return to their normal state within 12 months are 10 times more likely to have stress urinary incontinence at a later date than women who return to their pre-pregnancy state within 6 months.

The following factors are associated with a higher frequency of urinary incontinence in women:

Urinary incontinence is also associated with obesity. As many as 66% of obese women report having urinary incontinence. Urinary incontinence is the second most common gastrointestinal disorder in Canadian women and is more common than heartburn, indigestion and diarrhoea. Incidence increases with age, from 2% for women under 40 to over 15% for over 70-year-olds. One study found that 20% of 70-year-olds have urinary incontinence.