Continencia

Continencia, or continence, is the ability to control the elimination of urine and feces. In medical contexts, the term covers urinary continence and fecal continence, and the conditions in which this control is impaired are urinary incontinence and fecal incontinence.

Urinary continence is maintained by a coordinated interaction of bladder storage, urethral closure, pelvic floor muscles, and neural pathways. Urinary incontinence can be classified as stress, urge, mixed, overflow, or functional, reflecting different mechanisms such as inadequate sphincter function, detrusor overactivity, or impaired sensation. Fecal continence depends on the integrity of the anal sphincters, pelvic floor support, rectal sensation, and stool consistency. Fecal incontinence results from sphincter weakness or damage, impaired rectal sensation, or functional constipation.

Evaluation of continence disorders combines history, physical examination, and targeted tests. For urinary issues, bladder diaries, pelvic examination, urinalysis, and, when indicated, urodynamic studies are used. For fecal problems, assessment may include rectal examination, imaging, anorectal manometry, and endoanal ultrasound. Validated scoring systems help gauge symptom severity and treatment response.

Common etiologies include aging, childbirth-related pelvic floor injury, prostate surgery, neurological diseases, diabetes, obesity, and certain medications. Management is multimodal and individualized, ranging from lifestyle changes and pelvic floor muscle training to bladder or bowel retraining, pharmacotherapy (for example, antimuscarinics or beta-3 agonists for urinary symptoms), and dietary adjustments. When needed, devices, behavioral strategies, or surgical interventions such as slings, bulking procedures, sphincteroplasty, or neuromodulation may be employed.

Continence disorders affect quality of life and independence; many patients improve with conservative measures, though some require specialized medical or surgical care.