Brain abnormalities may contribute to the increased prevalence of urinary dysfunction such as overactive bladder and urge incontinence in older individuals. Functional brain imaging suggests that 3 independent neural circuits (frontal, midcingulate, and subcortical) control voiding by suppressing the voiding reflex in the brainstem periaqueductal gray.
Damage to the connecting pathways subserving these circuits (white matter hyperintensities) increases with age and is associated both with severity of urge incontinence and changes in brain function. Multicomponent therapies targeting structural and functional neural abnormalities may be more effective than any single treatment focused on the bladder.
Clinics in geriatric medicine. 2015 Aug 18 [Epub]
Phillip P Smith, George A Kuchel, Derek Griffiths
Urology Division, Department of Surgery, UConn Center on Aging, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA. Division of Geriatrics, UConn Center on Aging, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA. , Geriatric Medicine, University of Pittsburgh, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA 15213, USA.