{"id":4870,"date":"2025-11-22T17:42:44","date_gmt":"2025-11-22T22:42:44","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/?post_type=chapter&p=4870"},"modified":"2025-12-07T23:11:24","modified_gmt":"2025-12-08T04:11:24","slug":"incontinence","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/chapter\/incontinence\/","title":{"raw":"8p4 Incontinence \u2013 Types, Causes, and Treatments","rendered":"8p4 Incontinence \u2013 Types, Causes, and Treatments"},"content":{"raw":"Incontinence \u2013 Types, Causes, and Treatments<\/strong>\r\n

Incontinence<\/strong>:<\/h1>\r\nLoss of voluntary control over the bladder, leading to accidental peeing.\r\n

5 Types of Incontinence<\/strong><\/h1>\r\n

1. Enuresis (Bedwetting):<\/strong><\/h1>\r\n
    \r\n \t
  • Involuntary urination in children\u00a0older than four<\/strong>.<\/li>\r\n \t
  • In children\u00a0under four<\/strong>, it\u2019s considered normal due to immature nervous system development. The\u00a0nervous system<\/strong>\u00a0continues to mature into early adulthood (up to ~30 years).<\/li>\r\n \t
  • Causes of enuresis:<\/strong>\r\n
      \r\n \t
    • Delayed neural maturation<\/strong>.<\/li>\r\n \t
    • Psychosocial stressors<\/strong>\u00a0or disturbances.<\/li>\r\n \t
    • Usually\u00a0outgrown<\/strong> with age.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n

      2. Stress Incontinence:<\/strong><\/h1>\r\n
        \r\n \t
      • Caused by\u00a0increased intra-abdominal pressure<\/strong>\u00a0(coughing, sneezing, heavy lifting, laughing).\u00a0\u00a0 This pressure\u00a0forces urine out<\/strong>\u00a0through weakened sphincters or pelvic muscles.<\/li>\r\n \t
      • Pelvic Floor Muscle weakness:<\/strong>\u00a0Often due to\u00a0multiple pregnancies<\/strong>, aging, or hormonal changes. More common in\u00a0women<\/strong>.<\/li>\r\n \t
      • Treatment Strategies:<\/strong><\/li>\r\n<\/ul>\r\n
          \r\n \t
        • \r\n
            \r\n \t
          • Pelvic Floor Exercises: Kegel exercises<\/strong>\u00a0strengthen\u00a0pelvic floor muscles<\/strong>\u00a0and\u00a0urethral sphincters<\/strong>.\r\n
              \r\n \t
            • Improves urinary control by enhancing muscle tone around the bladder outlet.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t
            • Alpha-adrenergic agonists:<\/strong> Mimic\u00a0norepinephrine\/epinephrine<\/strong>.\r\n
                \r\n \t
              • Bind to alpha-adrenergic receptors <\/strong>on internal sphincter smooth muscles.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n
                  \r\n \t
                • \r\n
                    \r\n \t
                  • \r\n
                      \r\n \t
                    • Stimulate internal sphincters to\u00a0contract and close<\/strong>, reducing leakage.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n

                      3. Urge Incontinence:\u00a0<\/strong><\/h1>\r\n
                        \r\n \t
                      • Characterized by an\u00a0abrupt, strong urge to urinate<\/strong>.<\/li>\r\n \t
                      • Most common with\u00a0aging<\/strong>.<\/li>\r\n \t
                      • The person\u00a0must rush to the bathroom<\/strong>\u00a0and\u00a0can\u2019t hold it<\/strong>\u00a0for long, leading to frequent urination.<\/li>\r\n \t
                      • Cause:<\/strong>\r\n
                          \r\n \t
                        • Overactivity of the\u00a0detrusor muscle<\/strong>\u00a0(the bladder muscle), leading to involuntary contractions.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t
                        • Treatment:<\/strong>\r\n
                            \r\n \t
                          • Bladder training (timed bathroom trips), lifestyle adjustments (adopting healthy diet with fiber, fewer caffeinated beverages), stop smoking, building up pelvic floor muscles.\u00a0<\/strong><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n

                            4. Overflow Incontinence and Retention:\u00a0<\/strong><\/h1>\r\n
                              \r\n \t
                            • Occurs when the\u00a0bladder becomes overfilled<\/strong>.<\/li>\r\n \t
                            • Results from weakened bladder muscles failing to empty properly, leading to dribbling and frequent urination.<\/li>\r\n \t
                            • The detrusor muscle <\/strong>becomes\u00a0weak or insufficiently contractile<\/strong>.\u00a0 The\u00a0bladder<\/strong>\u00a0gradually\u00a0distends<\/strong>\u00a0and\u00a0overfills<\/strong>.<\/li>\r\n \t
                            • The increase in stretch weakens<\/strong> the detrusor muscle further, creating a\u00a0vicious cycle<\/strong>.<\/li>\r\n \t
                            • When the muscle cannot fully contract, urine remains <\/strong>in the bladder (residual urine).\u00a0 The residual volume causes the bladder to\u00a0fill up again faster<\/strong>, leading to frequency of urination.<\/li>\r\n \t
                            • As the bladder overflows<\/strong>, the pressure pushes urine through the\u00a0urethral sphincters<\/strong>, leading to\u00a0dribbling <\/strong>or involuntary leakage.<\/li>\r\n \t
                            • Risk factors<\/strong> include urethral blockages (e.g., prostate<\/strong> enlargement<\/strong>, renal calculi<\/strong>), in which case treatment should address the cause. Urethral strictures or scarring<\/strong> due to frequent infections or Trauma can also lead to Retention<\/strong> and then Overflow Incontinence.\u00a0 As can nerve<\/strong> damage<\/strong> (eg. spinal cord injury below T12<\/strong>), or medications (e.g., anesthesia<\/strong>) that impair nerve signalling.<\/li>\r\n \t
                            • Treatments<\/strong>:\r\n
                                \r\n \t
                              • Catheters, possibly adult absorption underwear, bladder training, surgical removal of obstruction, or nerve repair. Retention needs immediate treatment to prevent bladder damage.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t
                              • Note:\u00a0 Both Urge and Overflow Incontinence <\/strong>have common risk factors that include: aging<\/strong>, or nerve\/muscle dysfunction.\u00a0<\/strong><\/li>\r\n<\/ul>\r\n

                                5. Spinal Cord Injury & Neurogenic Bladder Types:<\/strong><\/h1>\r\n

                                Above T12 and brain injuries\/disease:<\/strong><\/h1>\r\n
                                  \r\n \t
                                • \r\n
                                    \r\n \t
                                  • Bladder contracts involuntarily<\/strong>\u00a0\u2014\u00a0spastic<\/strong> bladder (spastic, overactive, or hyperreflexic bladder)<\/strong>.<\/li>\r\n \t
                                  • Causes\u00a0frequent, involuntary urination<\/strong>\u00a0(incontinence).<\/li>\r\n \t
                                  • Treatment:<\/strong>\r\n
                                      \r\n \t
                                    • Usually\u00a0treated<\/strong>\u00a0with\u00a0anticholinergic drugs<\/strong>\u00a0to\u00a0relax<\/strong>\u00a0the detrusor muscle.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t
                                    • Risk factors<\/strong> include:\r\n
                                        \r\n \t
                                      • Brain damage (e.g., stroke<\/strong>), Neurological diseases (Multiple Sclerosis, Parkinson\u2019s Disease, Cerebral Palsy, Alzheimer\u2019s Disease, Encephalitis (viral or bacterial brain infection), Syphilis, Diabetes, Alcoholism (can cause neural damage)<\/strong>.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n \r\n

                                        Below T12:<\/strong><\/h1>\r\n
                                          \r\n \t
                                        • \r\n
                                            \r\n \t
                                          • Muscle is inappropriately relaxed<\/strong>\u2014flaccid<\/strong>\u00a0bladder (flaccid, underactive, or hyporeflexic bladder)<\/strong>.<\/li>\r\n \t
                                          • The\u00a0bladder overfills<\/strong>\u00a0because it\u00a0fails to contract<\/strong>\u00a0properly.<\/li>\r\n \t
                                          • Leads to overflow incontinence<\/strong>,\u00a0urinary retention<\/strong>\u00a0and\u00a0dribbling<\/strong>.<\/li>\r\n \t
                                          • Treatment:<\/strong>\r\n
                                              \r\n \t
                                            • Relax the\u00a0sphincters<\/strong>\u00a0by\u00a0blocking<\/strong>\u00a0norepinephrine\/epinephrine<\/strong>\u00a0receptors, allowing the sphincter to\u00a0relax<\/strong>\u00a0when appropriate and enable voiding<\/strong>.\u00a0 Use alpha-adrenergic blockers<\/strong>.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n
                                                \r\n \t
                                              • \r\n
                                                  \r\n \t
                                                • \r\n
                                                    \r\n \t
                                                  • Bladder management<\/strong>\u00a0involves controlling\u00a0urination timing<\/strong>\u00a0to prevent\u00a0bladder<\/strong> distention<\/strong>\u00a0and\u00a0detrusor<\/strong> muscle weakening<\/strong>.\u00a0 Catheter use may be required.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>","rendered":"

                                                    Incontinence \u2013 Types, Causes, and Treatments<\/strong><\/p>\n

                                                    Incontinence<\/strong>:<\/h1>\n

                                                    Loss of voluntary control over the bladder, leading to accidental peeing.<\/p>\n

                                                    5 Types of Incontinence<\/strong><\/h1>\n

                                                    1. Enuresis (Bedwetting):<\/strong><\/h1>\n
                                                      \n
                                                    • Involuntary urination in children\u00a0older than four<\/strong>.<\/li>\n
                                                    • In children\u00a0under four<\/strong>, it\u2019s considered normal due to immature nervous system development. The\u00a0nervous system<\/strong>\u00a0continues to mature into early adulthood (up to ~30 years).<\/li>\n
                                                    • Causes of enuresis:<\/strong>\n
                                                        \n
                                                      • Delayed neural maturation<\/strong>.<\/li>\n
                                                      • Psychosocial stressors<\/strong>\u00a0or disturbances.<\/li>\n
                                                      • Usually\u00a0outgrown<\/strong> with age.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                                                        2. Stress Incontinence:<\/strong><\/h1>\n
                                                          \n
                                                        • Caused by\u00a0increased intra-abdominal pressure<\/strong>\u00a0(coughing, sneezing, heavy lifting, laughing).\u00a0\u00a0 This pressure\u00a0forces urine out<\/strong>\u00a0through weakened sphincters or pelvic muscles.<\/li>\n
                                                        • Pelvic Floor Muscle weakness:<\/strong>\u00a0Often due to\u00a0multiple pregnancies<\/strong>, aging, or hormonal changes. More common in\u00a0women<\/strong>.<\/li>\n
                                                        • Treatment Strategies:<\/strong><\/li>\n<\/ul>\n
                                                            \n
                                                          • \n
                                                              \n
                                                            • Pelvic Floor Exercises: Kegel exercises<\/strong>\u00a0strengthen\u00a0pelvic floor muscles<\/strong>\u00a0and\u00a0urethral sphincters<\/strong>.\n
                                                                \n
                                                              • Improves urinary control by enhancing muscle tone around the bladder outlet.<\/li>\n<\/ul>\n<\/li>\n
                                                              • Alpha-adrenergic agonists:<\/strong> Mimic\u00a0norepinephrine\/epinephrine<\/strong>.\n
                                                                  \n
                                                                • Bind to alpha-adrenergic receptors <\/strong>on internal sphincter smooth muscles.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
                                                                    \n
                                                                  • \n
                                                                      \n
                                                                    • \n
                                                                        \n
                                                                      • Stimulate internal sphincters to\u00a0contract and close<\/strong>, reducing leakage.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                                                                        3. Urge Incontinence:\u00a0<\/strong><\/h1>\n
                                                                          \n
                                                                        • Characterized by an\u00a0abrupt, strong urge to urinate<\/strong>.<\/li>\n
                                                                        • Most common with\u00a0aging<\/strong>.<\/li>\n
                                                                        • The person\u00a0must rush to the bathroom<\/strong>\u00a0and\u00a0can\u2019t hold it<\/strong>\u00a0for long, leading to frequent urination.<\/li>\n
                                                                        • Cause:<\/strong>\n
                                                                            \n
                                                                          • Overactivity of the\u00a0detrusor muscle<\/strong>\u00a0(the bladder muscle), leading to involuntary contractions.<\/li>\n<\/ul>\n<\/li>\n
                                                                          • Treatment:<\/strong>\n
                                                                              \n
                                                                            • Bladder training (timed bathroom trips), lifestyle adjustments (adopting healthy diet with fiber, fewer caffeinated beverages), stop smoking, building up pelvic floor muscles.\u00a0<\/strong><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                                                                              4. Overflow Incontinence and Retention:\u00a0<\/strong><\/h1>\n
                                                                                \n
                                                                              • Occurs when the\u00a0bladder becomes overfilled<\/strong>.<\/li>\n
                                                                              • Results from weakened bladder muscles failing to empty properly, leading to dribbling and frequent urination.<\/li>\n
                                                                              • The detrusor muscle <\/strong>becomes\u00a0weak or insufficiently contractile<\/strong>.\u00a0 The\u00a0bladder<\/strong>\u00a0gradually\u00a0distends<\/strong>\u00a0and\u00a0overfills<\/strong>.<\/li>\n
                                                                              • The increase in stretch weakens<\/strong> the detrusor muscle further, creating a\u00a0vicious cycle<\/strong>.<\/li>\n
                                                                              • When the muscle cannot fully contract, urine remains <\/strong>in the bladder (residual urine).\u00a0 The residual volume causes the bladder to\u00a0fill up again faster<\/strong>, leading to frequency of urination.<\/li>\n
                                                                              • As the bladder overflows<\/strong>, the pressure pushes urine through the\u00a0urethral sphincters<\/strong>, leading to\u00a0dribbling <\/strong>or involuntary leakage.<\/li>\n
                                                                              • Risk factors<\/strong> include urethral blockages (e.g., prostate<\/strong> enlargement<\/strong>, renal calculi<\/strong>), in which case treatment should address the cause. Urethral strictures or scarring<\/strong> due to frequent infections or Trauma can also lead to Retention<\/strong> and then Overflow Incontinence.\u00a0 As can nerve<\/strong> damage<\/strong> (eg. spinal cord injury below T12<\/strong>), or medications (e.g., anesthesia<\/strong>) that impair nerve signalling.<\/li>\n
                                                                              • Treatments<\/strong>:\n
                                                                                  \n
                                                                                • Catheters, possibly adult absorption underwear, bladder training, surgical removal of obstruction, or nerve repair. Retention needs immediate treatment to prevent bladder damage.<\/li>\n<\/ul>\n<\/li>\n
                                                                                • Note:\u00a0 Both Urge and Overflow Incontinence <\/strong>have common risk factors that include: aging<\/strong>, or nerve\/muscle dysfunction.\u00a0<\/strong><\/li>\n<\/ul>\n

                                                                                  5. Spinal Cord Injury & Neurogenic Bladder Types:<\/strong><\/h1>\n

                                                                                  Above T12 and brain injuries\/disease:<\/strong><\/h1>\n
                                                                                    \n
                                                                                  • \n
                                                                                      \n
                                                                                    • Bladder contracts involuntarily<\/strong>\u00a0\u2014\u00a0spastic<\/strong> bladder (spastic, overactive, or hyperreflexic bladder)<\/strong>.<\/li>\n
                                                                                    • Causes\u00a0frequent, involuntary urination<\/strong>\u00a0(incontinence).<\/li>\n
                                                                                    • Treatment:<\/strong>\n
                                                                                        \n
                                                                                      • Usually\u00a0treated<\/strong>\u00a0with\u00a0anticholinergic drugs<\/strong>\u00a0to\u00a0relax<\/strong>\u00a0the detrusor muscle.<\/li>\n<\/ul>\n<\/li>\n
                                                                                      • Risk factors<\/strong> include:\n
                                                                                          \n
                                                                                        • Brain damage (e.g., stroke<\/strong>), Neurological diseases (Multiple Sclerosis, Parkinson\u2019s Disease, Cerebral Palsy, Alzheimer\u2019s Disease, Encephalitis (viral or bacterial brain infection), Syphilis, Diabetes, Alcoholism (can cause neural damage)<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                                                                                           <\/p>\n

                                                                                          Below T12:<\/strong><\/h1>\n
                                                                                            \n
                                                                                          • \n
                                                                                              \n
                                                                                            • Muscle is inappropriately relaxed<\/strong>\u2014flaccid<\/strong>\u00a0bladder (flaccid, underactive, or hyporeflexic bladder)<\/strong>.<\/li>\n
                                                                                            • The\u00a0bladder overfills<\/strong>\u00a0because it\u00a0fails to contract<\/strong>\u00a0properly.<\/li>\n
                                                                                            • Leads to overflow incontinence<\/strong>,\u00a0urinary retention<\/strong>\u00a0and\u00a0dribbling<\/strong>.<\/li>\n
                                                                                            • Treatment:<\/strong>\n
                                                                                                \n
                                                                                              • Relax the\u00a0sphincters<\/strong>\u00a0by\u00a0blocking<\/strong>\u00a0norepinephrine\/epinephrine<\/strong>\u00a0receptors, allowing the sphincter to\u00a0relax<\/strong>\u00a0when appropriate and enable voiding<\/strong>.\u00a0 Use alpha-adrenergic blockers<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
                                                                                                  \n
                                                                                                • \n
                                                                                                    \n
                                                                                                  • \n
                                                                                                      \n
                                                                                                    • Bladder management<\/strong>\u00a0involves controlling\u00a0urination timing<\/strong>\u00a0to prevent\u00a0bladder<\/strong> distention<\/strong>\u00a0and\u00a0detrusor<\/strong> muscle weakening<\/strong>.\u00a0 Catheter use may be required.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n","protected":false},"author":1370,"menu_order":7,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":["zoe-soon"],"pb_section_license":"cc-by-nc-sa"},"chapter-type":[],"contributor":[60],"license":[57],"class_list":["post-4870","chapter","type-chapter","status-web-only","hentry","contributor-zoe-soon","license-cc-by-nc-sa"],"part":59,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/4870","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/users\/1370"}],"version-history":[{"count":21,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/4870\/revisions"}],"predecessor-version":[{"id":5264,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/4870\/revisions\/5264"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/parts\/59"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/4870\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/media?parent=4870"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapter-type?post=4870"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/contributor?post=4870"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/license?post=4870"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}