Urinary incontinence

Urinary incontinence (UI) was a highly prevalent condition that increased with age and stress UI was the most common, dominant in late adulthood and the most understood (Minassian et al, 2017). The urethral support was responsible for continence which was located at the bladder neck and proximal urethra. The primary support of the bladder neck was an intact vaginal wall at the base of the bladder. The fibrous and muscular attachments to the pelvic side wall, the vagina was shown to act as a hammock to support the bladder neck which maintained continence. Stress UI was mainly the result of connective tissue laxity in the vagina and its supporting ligaments. The role of the suspensory ligaments was to support the proximal vagina and mid-urethra to maintain continence. Several etiological theories of UI suggested neurogenic, epithelial and myogenic involvement. A commonly accepted UI theory was the loss of inhibitory control by the central nervous system. In the micturition center in the brain that maintains continence, it was a disruption of the communication response by which it suppressed the urge to urinate. The epithelial hypersensitivity theory proposed the presence of chemo sensitizing agents which lead to bladder instability that existed in adult women with a history of childhood voiding dysfunction. The myogenic theory suggested that the pelvic floor might sustain a physical strain during developmental years in which the pelvic floor failed. The failure was due to birth injury, genetics, environmental factors that resulted in the loss of the ability to support the urethral continence mechanism during an urgency episode. Other UI proposed theories was influenced by psychosocial disturbances, inflammatory, and drug-induced conditions. The key feature in most bladder control conditions was urine loss which was difficult to accurately distinguish between different subtypes, especially when UI was severe (Minassian et al., 2017).

The etiology of urinary incontinence (UI) was multifactorial. The etiology of UI required a well-defined understanding of the mediators and modifiers of disease onset and progression. The primary associated risk factors included increased age, ethnicity, smoking, a history of incontinence, increasing body mass index, damage from prostate surgery, pregnancy, vaginal birth and overactive bladder syndrome. The compensatory mechanisms was brought on by diseases such as diabetes mellitus, impaired physical function and cognitive impairment. An association between depression and UI was reported, although it remains unclear whether there is a causal relationship between the two symptoms, or if they stem from separate causes (Giraldo‐Rodríguez et al., 2019). Increasing age was a well-recognized risk factor for UI in many population-based studies. The strong association with age and UI was not a normal part of aging and should never be solely attributed to it (Vaughn &Markland, 2020).

Giraldo‐Rodríguez, L., Agudelo‐Botero, M., Mino‐León, D., & Álvarez‐Cisneros, T. (2019). Epidemiology, progression, and predictive factors of urinary incontinence in older community‐dwelling mexican adults: Longitudinal data from the mexican health and aging study. Neurourology and Urodynamics, 38(7), 1932-1943. https://doi.org/10.1002/nau.24096

Minassian, V. A., Bazi, T., & Stewart, W. F. (2017). Clinical epidemiological insights into urinary incontinence. International Urogynecology Journal, 28(5), 687-696. https://doi.org/10.1007/s00192-017-3314-7

Vaughan, C. P., & Markland, A. D. (2020). Urinary incontinence in women. Annals of Internal Medicine, 172(3), ITC17-ITC32. https://doi.org/10.7326/AITC202002040