Kontinens

Kontinens refers to the ability to control urination and defecation. Maintaining continence is a normal function for most people, while incontinence means a loss of control and leakage from the urinary or gastrointestinal tract. The term covers urinary continence and fecal continence.

Urinary continence can be affected by several forms, including stress incontinence, urge incontinence, mixed incontinence, and overflow incontinence, each with distinct mechanisms. Fecal continence relies on the anal sphincter and pelvic floor; fecal incontinence may result from sphincter damage, nerve injury, or impaired sensation. Functional incontinence arises when mobility or cognition limits toilet access despite intact continence.

Causes and risk factors include aging, pregnancy and childbirth, menopause, prostate surgery, obesity, diabetes, neurological disorders (stroke, spinal cord injury, Parkinson's), infections, medications, and constipation or chronic coughing.

Assessment includes medical history, symptom diary, and physical exam, with urinalysis to detect infection or diabetes. Further tests may involve ultrasound or bladder function studies; urodynamics and anorectal testing are used for specific suspected issues.

Treatment is individualized and often multimodal. For urinary incontinence, options include lifestyle changes, pelvic floor exercises, bladder training, medications, and, if needed, surgical approaches such as slings, artificial sphincters, or neuromodulation. For fecal incontinence, management includes diet adjustments, medications, biofeedback, bulking agents, and, in severe cases, surgical procedures or stoma installation.

Impact on quality of life is substantial; prevalence increases with age. Many individuals benefit from early evaluation and a multidisciplinary care plan; reducing stigma and improving access to care are important public health goals.