Continence Facts
(Information provided by SCA Hygiene Products)

Urinary Incontinence
Urinary incontinence is a common symptom involving an involuntary urinary leakage to such an extent that it becomes a social as well as a hygienic problem (according to International Continence Society, ICS). The definition according to the ACA (Association of Continence Advisors) is:

"Incontinence is the involuntary loss of urine and/or faeces at an inappropriate moment or in an inappropriate place. The leakage volume can vary from very small to considerable. Incontinence is not an illness, it is a symptom that indicates a disturbance in your body functions."

Continence is dependent on the function of the bladder and the urethra. The bladder has the function of a container, which collects the urine under low pressure. If this does not work properly, urine will involuntary leak from the bladder. This represents one form of incontinence.

The bladder should in addition work as a pump, normally controlled by signals initiating voluntary evacuation of the bladder. If these signals cannot be, the bladder empties itself involuntarily. The urethra acts as an infection barrier at the same time as it helps maintain continence (hold the urine). Muscles and nerves regulate continence. The area consisting of the lower part of the bladder together with the upper part of the urethra builds the internal sphincter. There is also an area called the external sphincter muscle. These two groups of muscles are part of continence both active continence where we can control it, and passive continence which prevents us from constant leakage. Even if any one of these two groups of sphincter mechanisms malfunctions, one can still be continent.

Normal urinary volume per day: 1-2 litters
Normal bladder volume: 3-5 dl
Micturation frequency: 4-7 times per day

The micturation center is connected to the lower parts of urethra via the cerebral cortex of the cerebrum.

The bladder is filled under low pressure. When the bladder contains approx. 2-3 dl of urine, signals are given via peripheral nerves and the introspective nerves in the spinal marrow to the centers in the brain. This is experienced as the bladder is being filled and results in urinary urge.

The reflex to urinate is then initiated from the cerebral cortex, and via the extrovert nerves in the spinal marrow together with the peripher nerves, impulses are given which result in contraction of the bladder muscles and consequently the bladder is emptied.

Prevalence
Conclusions drawn from the large number of international surveys estimate that 10-15% of all women and approximately 5% of all men suffer from urinary incontinence.

Stress Incontinence Among Females
Mild incontinence is treated with physical therapy, i.e. exercising the pelvic muscles, as well as with drugs. If there is reason to suspect deficient muscle function in the urethra, in cases of stress incontinence, drugs that improve this can be given. Treatment with Oestriol can be a useful complement for post-menopausal women since the urethra and vagina tissue might have become more thin and dry at this stage.

More severe incontinence (leakage without physical exertion, for instance when standing up) should be treated surgically.

Stress Incontinence Among Males
If leakage appears after prostate surgery due to injury to the urethral sphincter muscle, a positive effect can be achieved by exercising the pelvic muscles. If improvement is not achieved by this, an artificial sphincter muscle can be surgically implanted.

Urge Incontinence Among Females And Males
Urge incontinence caused by excess irritability of the bladder muscles is primarily treated with bladder exercises aiming to increase the time elapsing between bladder emptying.

Other alternatives are pharmacological treatments and electro-stimulation.

Overflow Incontinence Among Males
An outflow obstruction is usually caused by an enlargement of the bladder due to residual urine. The patient is normally treated with catheter until kidney function and fluid balance is normal and the obstructed outflow is then removed.

SCA Hygiene Products is the world leader in incontinence care products, with the brand names Promise® and TENA®, and a leading supplier of skin care products. We sell our products in over 40 countries around the world to the at-home market as well as the institutional marketplace.

Visit our international website at http://www.tena.com/

SCA Hygiene Products may from time to time substitute packaging and/or adopt a new trademark in connection with the products sold hereunder; provided, however, that the underlying product will remain unchanged and that pricing will be unaffected.

Promise and TENA are registered trademarks of SCA HYGIENE PRODUCTS, AB.