Urinary control relies on the finely coordinated activities of the smooth muscle tissue of the urethra and bladder, skeletal muscle, voluntary inhibition, and the autonomic nervous system.
Urinary incontinence can result from anatomic, physiologic, or pathologic (disease) factors. Congenital and acquired disorders of muscle innervation (e.g., ALS, spina bifida, multiple sclerosis) eventually cause inadequate urinary storage or control.
Acute and temporary incontinence are commonly caused by the following:
Chronic incontinence is commonly caused by these factors:
Of the several types of urinary incontinence, stress, urge, and mixed incontinence account for more than 90% of cases. Overflow incontinence is more common in people with disorders that affect the nerve supply originating in the upper portion of the spinal cord and older men with benign prostate hyperplasia (BPH). The primary characteristics of these types are as follows:
The U.S. Department of Health and Human Services reported in 1996 that approximately 13 million people in the United States suffer from urinary incontinence. The condition is far more prevalent in women than men. In the general population aged 15 to 64 years old, 10-30% of women versus 1.5-5% of men are affected. At least 50% of nursing home residents are affected. Of that number, 70% are women.
A complete medical history, which includes a voiding diary and incontinence questionnaire; physical examination; and one or more diagnostic procedures help the physician determine the type of urinary incontinence and an appropriate treatment plan.
The physical examination also helps the physician identify medical conditions that may be the cause of incontinence. For instance, poor reflexes or sensory responses may indicate a neurological disorder.
The multichannel, or subtracted, cystometrogram simultaneously measures intra-abdominal, total bladder, and true detrusor pressures. This allows involuntary detrusor contractions to be distinguished from increased intra-abdominal pressure. The voiding cystometrogram detects outlet obstruction in patients who are able to void.
Uroflowmetry identifies abnormal voiding patterns. Urethral pressure profilometry measures the resting and dynamic pressures in the urethra.
There are several things patients can do to help improve continence.
A number of protective devices are available to help manage accidental urination, including the following:
Early reliance on absorbent pads may cause the wearer to accept incontinence rather than seek diagnosis and treatment. These products should be applied correctly and changed often to prevent skin irritation and urinary tract infection.
Treatment for adrenal cancer depends on the stage of the disease at diagnosis. Options include surgery, chemotherapy, and radiation. Treatment for patients with functioning tumors usually involves using medications to manage symptoms.
Pheochromocytomas require neoadjuvant (before surgery) treatment for high blood pressure, which often includes alpha-blockers (e.g., phenoxybenzamine, prazosin) followed by beta-blockers (e.g., propranolol), and metyrosine.
Mitotane (Lysodren®) suppresses adrenal gland function and is the drug of choice to treat inoperable adrenal cancer. Approximately 20% of adrenal cancer patients respond to treatment with mitotane. Side effects include gastrointestinal disturbances (e.g., loss of appetite, nausea, vomiting, diarrhea) and neurological disturbances (e.g., depression, lethargy, sleepiness). When mitotane therapy fails, cisplatin (Platinol®) may be tried, alone or combined with other agents. Drug combinations used include the following:
Neuroblastoma may be treated with adjuvant (in addition to surgery) chemotherapy using carboplatin (Paraplatin®), cyclophosphamide, doxorubicin, and etoposide (Vepesid®).
Side effects of chemotherapy are often severe and include gastrointestinal disturbances, low blood count , skin disorders, and neurological disorders.
of Functioning Tumors
Increased cortisol production (Cushing's syndrome) is often treated with aminoglutethimide or ketoconazole (Nizoral®) to inhibit cortisol build-up (synthesis). They may be used alone, or in combination with chemotherapy. Side effects include nausea, vomiting, and abdominal pain.
Excess aldosterone production (Conn’s syndrome) is usually treated using spironolactone (Aldactone®). Spironolactone is an aldosterone antagonist (i.e., counteracts the action of aldosterone). Side effects include ulcers, abnormal breast enlargement in men (gynecomastia), fever, and headache.
Aromatase inhibitors such as anastrozole (Arimidex®) and anti-androgens such as bicalutamide (Casodex®) may be used to treat excessive androgen production.