Ischemic Etiology of Incontinence in Women: A Theory and A Review

Incontinence in women is a major health problem. In a recent study, incontinence affects more than 10 million Americans, 85% of whom are women. Incontinence can result in an extremely altered life style, and is the main reason that women are admitted to nursing homes. Care for the incontinent patient represents an enormous expense nationally. The emphasis of this review is on the relevance of estrogen-dependent ischemia to urethral smooth muscle tone and tonic α -adrenergic tension in the maintenance of continence in women. Additionally, the role of ischemia in bladder dysfunction will be explored. In general, the relative contribution of smooth muscle tension is greater in females than in males. It is clear from both animal and human data that during bladder filling there is a progressive increase in sympathetic stimulation of the urethra resulting in increased α -adrenergic tension.