Abstract: A History of Continence

Jerzy Gajewski, MD, FRCSC and Donalee Moulton. "A History of Continence." Linacre's: The Chronicle of Medical Progress and Culture (1997): 18-22.

Objectives:
* To provide an overview of the history of urinary incontinence, from ancient times to the present, and show how attitudes and methods of dealing with the problem have changed over time.

Key Points:
* Incontinence was treated by doctors in ancient Greece, who invented catheterization.
* During the twentieth century, doctors began to treat incontinence by surgery, as surgical techniques underwent significant advancement. Because it was originally believed that incontinence resulted from problems with the urethral muscle, surgeons tried to solve the problem by tying the meatus to make it tighter. This was unsuccessful, since incontinence is most often caused by problems in the pelvic floor and bladder neck areas.
* There are several different types of incontinence, including stress incontinence, urge incontinence, mixed incontinence, and overflow incontinence. Treatment varies depending on the type of condition. For stress incontinence, surgery is often recommended, and is considered by many doctors to be the most effective therapy. Less invasive forms of treatment can also be effective, however. Pelvic muscle exercises, such as Kegel exercises can correct mild stress incontinence in many women.
* It is now more socially acceptable to discuss urinary incontinence and to seek treatment for it, which is itself a significant advance in urology. Incontinence is associated with old age, but it is not a normal and unavoidable consequence of aging. "Rather, changes in lower urinary tract function predispose the older person to this condition.""
* "Urinary incontinence can have devastating effects on the quality of life of affected individuals. . . . Trips outside the home, social interaction with friends and family, and sexual activity may be restricted or avoided entirely as a result . . . . More than 10 million adults throughout North America suffer [from incontinence]. The financial cost of managing this disease is estimated at more than $10 billion a year, and this is a conservative estimate."

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