Incontinence may involve problems with which structures?

• A. Urinary bladder
• B. Internal urethral sphincter
• C. External urethral sphincter
• D. All of the above

Answer: (D)

Continence depends on the bladder storing urine without contracting and the outlet remaining closed and supported. If the bladder’s storage function is impaired—such as detrusor overactivity or poor bladder compliance—urine can leak from the bladder itself. If the internal urethral sphincter at the bladder neck fails to stay closed, leakage can occur even at low volumes. If the external urethral sphincter or the surrounding pelvic floor is weak, increases in pressure (coughing, lifting) can overcome closure and cause leakage. Since incontinence can arise from problems at any of these points, it may involve the urinary bladder, the internal urethral sphincter, and the external urethral sphincter. All of the above.