Total Incontinence

Total urinary incontinence refers to the continuous leakage of urine day and night . The bladder is unable to retain any urine at all.

Causes

Total incontinence occurs when the “gateway” of the bladder known as the external urinary sphincter is either damaged or bypassed by an abnormal tract connecting the urinary system to the vagina (called a fistula).

• Damage to the external urinary sphincter : This occurs when the muscles or the nerve supply to the sphincter is damaged, for example after prostate surgery or after sustaining a serious pelvic injury. (Fig. 1)
• Fistula formation: Total or continuous leakage also occurs when an abnormal passageway known as a fistula is formed between the urinary system and the vagina. (Fig. 2)

Fig. 1

Fig. 2

Treatment

Treatment for total incontinence depends on the cause. If a fistula is present, surgery may be able to close the leak.

In sphincteric damage, artificial sphincters may be implanted if the underlying disease process is amenable to surgical removal/correction. If this is not possible, urinary diversion may be considered.

If surgery is not possible or inadvisable, patients may have to rely on continence aids, catheters or absorbent products.

Absorbant pads

Adult diapers

Pull-up pants

Washable pants / briefs