Urinary Incontinence, a medical, psychological, social, economic, and hygienic problem, is defined as a condition of loss of the bladder to control that can lead to mild or severe form of involuntary leakage of urine. Involuntary urine leakage or urinary incontinence is frequent among elderly women, adult women, even among adolescent women

I. Symptoms of Urinary incontinence
In the observation to determine the incidence and resolution rates of different types of urinary incontinence in Australian women and examined the course of urinary incontinence with or without treatment, showed that At baseline and followup 442 women provided data. Mean ± SD age was 59.28 ± 12.1 years at followup. The total incidence of any new urinary incontinence was 17% (95% CI 12.4-21.6) in unaffected women and the total resolution rate was 16.8% (95% CI 11.4-22.2) in women with urinary incontinence during 2 years regardless of receiving treatment for urinary incontinence. There was also movement of women among the diagnoses of stress only, urge only and mixed urinary incontinence during followup. A total of 34 women reported having received treatment for urinary incontinence and 5 experienced resolution of the condition. All types of urinary incontinence were associated with impaired quality of life (p <0.001) and adversely impacted daily activity. A negative impact on quality of life (p = 0.02) was also observed in incident cases at followup compared with baseline(1). Symptoms of urinary incontinence depending to the types of conditions, including
1. Stress incontinence
Stress urinary incontinence (SUI) has a significant impact on the quality of life for many women(2).It is defined as a condition of leakage of urine during physical activity, such as coughing, sneezing, laughing, exercising, etc. as a result of weakening the the sphincter pelvic muscles, supporting the bladder and urethra.  A. sample comprised by a group of 154 adolescents aged 13 to 18 from a charter school and questionnaire was developed to obtain information about possible urine leakage and a pilot test was run in order to verify its accuracy show that 94.2% of participants suffer from urinary incontinence occasionally. Another significant finding reveals that 27% of case reports had suffered from urinary tract infection (UTI) and participants felt upset about it(2a).

2. Urge incontinence
Urge incontinence, also known as overactive bladder,  is defined as a condition of involuntary loss of urine and  intense urge to urine as a result of  bladder spasms or contractions with no apparent reason. incontinence is also called overactive bladder. 

3. Overflow incontinence
Overflow incontinence is defined as a condition of bladder inability to empty completely and normal flow of urine is blocked that can lead to constantly urine dribbling.

4. Mixed incontinence
Mixed incontinence is defined as condition of combination of stress incontinence and urgency incontinence.

5. Functional incontinence
Functional incontinence is defined as a condition of functioning difficulty that prevent one to urinr normally as a result of mental or physical disabilities. 
 

6. Total incontinence
Total incontinence is defined as a condition of total loss of urine control as a result of certain conditions such as bladder fistula, injury to the urethra, ectopic ureter, etc.

II. Causes and risk factors
B. Risk factors
1. Gender
If you are women, you are at increased risk of stress urinary incontinence, but men with enlarged prostate are also at higher risk of the conditions.

2. Age
Risk of Urinary incontinence is increased with age as a result of weakening of  the muscles of the bladder and strength of urethra.

3. Smoking
In the study of  606 women whose smoking histories were known; 322 were incontinent and 284 were continent. The condition(s) causing each subject’s incontinence was determined by urodynamic testing; 40% of the continent subjects had the same testing, indicated that the odds ratio for genuine stress incontinence was 2.20 for former (95% confidence interval 1.18 to 4.11) and 2.48 for current smokers (95% confidence interval 1.60 to 3.84); for motor incontinence it was 2.92 for former (95% confidence interval 1.58 to 5.39) and 1.89 (95% confidence interval 1.19 to 3.02) for current smokers(3).

4. Hysterectomy 
Hysterectomy in general, in particular vaginal hysterectomy, was associated with an increased risk for subsequent POP and SUI surgery.(4)

5. Other risk factors
In the study to study to determine the prevalence and potential risk factors associated with urinary incontinence (UI) in women and to assess its impact on quality of life (QOL), Dr. Kocaöz S, and the research team showed that the prevalence of UI was 31.9%. Logistic regression analysis indicated that the number of pregnancies (odds ratio [OR] = 0.53, 95% CI: 0.28-0.99), UI in mother (OR = 2.46, 95% CI: 1.35-4.50) and sister (OR = 0.34, 95% CI: 0.16-0.77), previous UI during pregnancy (OR = 12.22, 95% CI: 4.11-36.36) and postpartum period (OR = 11.28, 95% CI: 3.66-34.76), and body mass index (OR = 0.49, 95% CI: 0.29-0.85) were associated with a higher likelihood of incontinence (P < .05). Ninety-two of 288 women (31.9%) stated that UI has a negative impact on their QOL and only 40 of 92 (43.5%) had asked for medical help. Impairment of QOL was related with the type of UI, frequency of UI episode, and amount of leakage(5). Other researchers in the study of a total of 621 women of those initially selected in the study died before completion of this study. Face-to-face interviews with 1,521 women were completed, producing a response rate of 85.0% (1,521/1,789 women). The prevalence of daytime urinary frequency was significantly related to body mass index (p = 0.018), diabetes mellitus (p = 0.017), hypertension (p = 0.015), previous drug allergy (p = 0.003), smoking (p = 0.005), hormone therapy (p = 0.019), parity (p = 0.019), and urinary incontinence (p = 0.000). However, there was no association between urinary frequency and previous gynecologic surgery, hysterectomy, alcohol consumption, marital status, childbirth, and age of menopause(6).

6. Etc.

B. Causes 
1. Interstitial cystitis/painful bladder syndrome 
Dr. Chung MK, and scientists at the Midwest Regional Center for Chronic Pelvic Pain, indicated that Many patients with symptoms of overactive bladder with little or no pain have cystoscopic evidence of interstitial cystitis and a positive Potassium Sensitivity Test(7).

2. Prostatitis
Inflammation of prostate gland in men can cause urinary incontinence Loss of bladder control. There is a report of a case of total urinary incontinence as a late sequela of bacterial prostatitis is reported. The etiology of the incontinence and its surgical management are discussed(8)


3. Enlarged prostate or benign prostatic hyperplasia (BPH)

  Enlarged prostate can cause narrowing of the urinary track which can cause Urinary Incontinence. Urinary incontinence (UI) and benign prostatic hyperplasia (BPH) are 2 common urogenital problems in men. UI is associated with involuntary leakage of urine and lower urinary tract symptoms (LUTS) of urgency, frequency, and nocturia. Types of UI include functional, urge, stress, and overflow. Treatment for UI is based on the type of incontinence, patient-specific factors, and treatment preferences of both patients and health care providers(9).

4. Prostate cancer
In the study to review the current knowledge and treatment of incontinence and erectile dysfunction after treatment of localized prostate cancer, found that nursing care of men undergoing treatment of prostate cancer begins at the time of diagnosis and continues throughout the management of the two main adverse effects of treatment: erectile dysfunction and urinary incontinence(10).


 5. Bladder cancer 
“Women with SUI the Serbian urologist traditionally begins with cystoscopy to reduced risk of bladder tumor. There is no doubt regarding its ability to detect bladder cancer presented with characteristic symptoms or pathologic results of urinalyses” Dr. Topuzović C, and the research team at Clinical Center of Serbia said(11)

6. Cognitive disorders
Urinary incontinence is a common problem in dementia as a result of the disease interfere with nerve signals involved in bladder control. Dr. Yap P, and Tan D. at Alexandra hospital  in the study of Urinary incontinence in dementia – a practical approach, said “Almost invariably, the person with dementia will develop incontinence as the disease progresses. However, the primary reasons for incontinence are often not because of any significant pathology in the urinary system. Rather, it is due to factors outside the urinary system”(12).



7. Constipation
In the study to evaluate the frequency of urinary incontinence and urinary tract infection in children with chronic constipation and report on the resolution of these with treatment of the underlying constipation, showed that urinary symptoms were found in a significant number of children who had functional constipation and encopresis. With treatment of the constipation, most patients became clean and dry and further recurrence of urinary tract infections was prevented(13).

8. Other causes
In the assessment of the EPIC participants, 1434 identified OAB cases were matched by age, gender and country, with 1434 participants designated as controls. Cases and controls were primarily Caucasian (96.2% and 96.7%, respectively), and most (65%) were female; the mean age was 53.8 and 53.7 years, respectively, found that comorbid conditions differed significantly by case/control status, with cases reporting significantly greater rates of chronic constipation, asthma, diabetes, high blood pressure, bladder or prostate cancer, neurological conditions and depression. There were significant differences between the cases and controls in all reported LUTS. The OAB + postmicturition + voiding group reported significantly greater symptom bother, worse HRQoL, higher rates of depression and decreased enjoyment of sexual activity, than the other subgroups(14).

9. Etc.

III. Complications
1. Dermatitis 
Urinary incontinence are associated with with increased risk of dermatitis. Dr. Beldon P. at the Epsom & St Helier University Hospitals NHS, indicated that Older people’s skin is subject to dehydration internally and environmental factors externally. If, in addition, the individual suffers continence problems, he or she is at risk of painful incontinence-associated dermatitis, or even formation of a moisture lesion(15).

2. Urinary tract infections. Risk of urinary tract infections with untreated urinary incontinence. In the study of Twenty-nine percent complained of daytime urinary incontinence and 34% of nighttime urinary incontinence. Urinary tract infection was present in 11% and was more commonly present in girls than in boys (33% vs 3%). Vesicoureteral reflux was present in four and megacystis in four of the 25 children who had a voiding cystourethrogram because of urinary tract infection(16).

3. Impaired quality of life
Urinary Incontinence can interfere with patient’s quality of life. In the study of quality of life in women with urinary incontinence is impaired and comparable to women with chronic diseases, Scientists at the The Chinese University of Hong Kong showed that women with urinary incontinence had impaired quality of life and it was comparable to other chronic medical diseases. Women with detrusor overactivity have more impaired quality of life than women with urodynamic stress incontinence. Severity of urodynamic stress incontinence did not correlate with quality of life. Women who opted for continence surgery had poorer quality of life(17). Other study indicated that women in mixed, USI and IDO categories had significantly worse QoL scores in the domain Severity Measures than women in sensory or normal categories (P < 0.0001). Incontinence Impact was significantly worse in mixed and IDO categories compared with normal (P = 0.006) but not compared with women with USI. Sleep/Energy scores were significantly worse for women in mixed and IDO categories compared with women with USI (P = 0.003)(18).

6. Etc.

IV. Diagnosis and tests
After completing  family and medical history, including a voiding diary, incontinence questionnaire , directed family member who have past history of the same diseases, bowel habits, patterns of urination and leakage etc., a  physical examination of of the abdomen, rectum, genitals, and pelvis with the the cough stress test, can be helpful to determine the type of urinary incontinence. The tests that your doctor orders may include
1. Urine test
  A sample of your urine is sent to a laboratory, where it’s checked for signs of infection, traces of blood or other abnormalities. 

2. Blood test
A sample of your  blood is checked for chemicals and substances related to causes of incontinence.

3. Postvoid residual (PVR) volume test
Postvoid residual (PVR) volume test is the test to the amount of leftover (residual) urine in your bladder after you’re asked to urinate. In the study to  estimate the prevalence and clinical and urodynamic associations of postvoid residual volumes (PVRs), measured immediately after micturition, in women with symptoms of pelvic floor dysfunction, found that the overall prevalence of PVRs was 76% at 0-10 mL, 5% at 11-30 mL, 5% at 31-50 mL, 8% at 51-100 mL, and 6% at more than 100 mL. Thus, using transvaginal ultrasonography, 81% of immediate PVRs were 30 mL or less. Higher than 30 mL, a significantly increased prevalence of women presenting with recurrent urinary tract infections (UTIs) was noted (P<.001). The level of 30 mL was deemed to be an appropriate upper limit of normal PVR. The prevalence of PVRs higher than 30 mL increased significantly with age (P<.001) and higher grades of prolapse (P<.001). There was a significant inverse relation of PVRs higher than 30 mL to the symptom of stress incontinence (P=.018) and the diagnosis of urodynamic stress incontinence (P<.001)(19).

4. Pelvic ultrasound.
Pelvic Ultrasound is the test to exam the pelvic region, including the urinary tract or genitals to check for abnormalities. Dr. Dalpiaz O, and Dr. Curti P. at the University of Verona, showed that Ultrasound has become an indispensable diagnostic procedure in urogynecology. Perineal, introital, and endoanal ultrasound are the most recommended techniques and the results comprise qualitative and quantitative findings. These are important for determining the localization of the bladder neck and vesico-urethral junction and also for pre- and postoperative comparisons, and moreover for clinical applications and scientific investigations(20).

5. stress urinary incontinence Q-tip test
Q-tip test is a test with a cotton-tipped stick lubricated with xylocaine gel is placed into the urethra up to, but not through the internal urethral sphincter (Q-tip test). With straining or coughing, the stick rises more than 30 degrees from it’s resting angle. This demonstrates urethral hypermobility and differentiates genuine stress incontinence from an intrinsic urethral sphincteric insufficiency (ISD) without hypermobility(21).

6. Urodynamic testing. These tests measure pressure in your bladder when it’s at rest and when it’s filling. A doctor or nurse inserts a catheter into your urethra and bladder to fill your bladder with water. Meanwhile, a pressure monitor measures and records the pressure within your bladder. This test helps measure your bladder strength and urinary sphincter health, and it’s an important tool for distinguishing the type of incontinence you have(22).  

7. Cystogram
A cystography is a procedure that your doctor can visualise the urinary bladder with X-ray of the bladder by the injects a fluid containing a special dye. In the study to compare the urodynamic findings and results of lateral cystourethrography in 82 patients with incontinence, showed that a significantly higher increase of the posterior urethrovesicular angle was noted in patients with a urodynamic stress incontinence than in patients with urge incontinence or those with normal urodynamic findings. Lateral cystourethrography as compared to urodynamic assessment, proved to be a method with high sensitivity (91%) but little specificity. These two methods supply different but complementary data. Together with history, assessment of patients’ complaints, clinical vaginal examination, and clinical stress test they offer valuable information for an efficient therapeutic concept(23).

8. etc.

V. Preventions: The do’s and do not’s list 
1. Reduce weight if you are overweight or obese
Obesity is an established and modifiable risk factor for urinary incontinence, In the study of  338 overweight and obese women with at least 10 urinary-incontinence episodes per week to an intensive 6-month weight-loss program that included diet, exercise, and behavior modification (226 patients) or to a structured education program (112 patients), showed that a 6-month behavioral intervention targeting weight loss reduced the frequency of self-reported urinary-incontinence episodes among overweight and obese women as compared with a control group. A decrease in urinary incontinence may be another benefit among the extensive health improvements associated with moderate weight reduction(24)

2. Follow guidance of fluid intake if you have Urinary Incontinence as over intake of fluid is associated to increased risk of bladder leaking.

3. Exercise
Dr. Bø K. at the Norwegian University of Sport and Physical Education, said “Strength training of the pelvic floor muscles has been shown to be effective in treating stress urinary incontinence in parous females in the general population. In randomised controlled trials, reported cure rates, defined as <2g of leakage on pad tests, varied between 44% and 69%. Pelvic floor muscle training has no serious adverse effects and has been recommended as first-line treatment in the general population. Use of preventive devices such as vaginal tampons or pessaries can prevent leakage during high impact physical activity. The pelvic floor muscles need to be much stronger in elite athletes than in other women.” in the study of Urinary incontinence, pelvic floor dysfunction, exercise and sport(25).

4. Avoid bladder irritants
Frequent over drinking and certain foods can cause bladder irritant of that can increase the risk of Urinary Incontinence.

5. Quick smoke if you smoke, quit. If you don’t smoke, don’t start(26)

6.  Avoid frequent constipation as it is a leading cause of  Urinary Incontinence by Including more fiber in your diet. Urinary symptoms were found in a significant number of children who had functional constipation and encopresis(27).

7. Etc.

VI. Treatments
A. In conventional medicine perspective
A.1. Non medical treatment
In the study to investigate of  total of 33 interventional studies found that toileting programs and incontinence pads are the mainstays of treatment, with some studies implying significant economic and labor costs, drug therapy as an adjunct to toileting programs has so far shown only moderate benefits, combined physical therapy/behavioral therapies have shown effective short-term improvements. Adaptations to physical environment and staff training techniques might also be paramount, exercise and Functional Incidental Training programs, although expensive, might provide additional benefit by reducing wetness rates and improving appropriate toileting rates. combined complex behavioral interventions are now a common feature and their effectiveness for the management of urinary incontinence should be determined in future studies(28).
1. Physical therapy
Stress urinary incontinence (SUI) is an involuntary release of urine through the urethra during the increase of abdominal pressure in the absence of m. detrusor contraction, in the study of[Physical therapy in the treatment of stress urinary incontinence], showed that strengthening of pelvic floor muscles by exercises results in a significant increase of pelvic floor muscle strength and reduction of SUI symptoms, regardless of the used exercise program, PNF spiral dynamic technique or Kegel exercise program(29).

2. Behavioral therapies
In the study to to identify correlates of patient satisfaction with drug and behavioral treatments for urge-predominant incontinence, researchers found that clinical trial randomizing 307 women to 10 weeks of tolterodine alone or combined with behavioral training. Satisfaction was measured using the Patient Satisfaction Question (PSQ). Potential correlates included baseline demographics, incontinence characteristics and prior treatments, history and physical parameters, expectations of treatment success, and outcome variables including the Global Perception of Improvement (GPI) and Urogenital Distress Inventory (UDI)(30).

3. Individual biofeedback
Four weeks of both intensive group physical therapy or individual biofeedback training followed by an unsupervised home exercise program for 2 mo are effective therapies for female urinary stress incontinence and result in a significantly reduced nocturnal urinary frequency and improved subjective outcome. Only group physical therapy resulted in reduced daytime urinary frequency. BF therapy resulted in a better subjective outcome and higher contraction pressures of the pelvic floor muscles said Dr. Pages IH and the research team at the University Hospital Charité, Humboldt University(31).

4. EMG relaxation
There is a report of a 27-year-old woman with chronic urinary retention and incontinence since infancy was treated for 8 months with frontal electromyographic relaxation training. Urinary control and sensations of bladder fullness were obtained for the first time in the patient’s history. Residual urine readings showed marked improvement(32).

5. Etc.

A.2. Medical treatments
Medication used to treat Urinary Incontinence often are accompanied with therapical treatments and depended on the causes of the diseases
A.2.1. Medication 
1. Anticholinergics
 a. Anticholinergics often used to treat overactive bladder of patients with urge incontinence, but in many case it is used  patients with dementia and urge incontinence, this combination would seem to violate basic principles of geriatric pharmacology, as the drugs appear to be working at cross-purposes and anticholinergic medications are notorious for worsening cognitive function in susceptible patients(33)
b. Side effects are not limit to
b.1. Dry mouth and dry warm skin
b.2. Constipation
b.3. Blurred vision
b.4. Flushing
b.5. Increased heart rate
b.6. Headaches
b.7. Confusion
B.8. Etc.

2. Hormone therapies
a. Urge urinary incontinence is more prevalent after the menopause, and the peak prevalence of stress incontinence occurs around the time of the menopause. Many studies, however, indicate that the prevalence of stress incontinence falls after the menopause. Until recently, estrogen, usually as part of a hormone replacement therapy (HRT) regimen, was used for treatment of urinary incontinence in postmenopausal women. Although its use in the treatment of vaginal atrophy is well established, the effect of HRT on urinary continence is controversial. A number of randomized, placebo-controlled trials have examined the effects of estrogen, or estrogen and progestogen together, in postmenopausal continence and concluded that estrogens should not be used for the treatment of urge or stress incontinence(34). Other suggested that Local oestrogen treatment for incontinence may improve or cure it, but there was little evidence from the trials on the period after oestrogen treatment had finished and none about long-term effects. However, systemic hormone replacement therapy, using conjugated equine oestrogen, may make incontinence worse. There were too few data to reliably address other aspects of oestrogen therapy, such as oestrogen type and dose, and no direct evidence on route of administration. The risk of endometrial and breast cancer after long-term use suggests that oestrogen treatment should be for limited periods, especially in those women with an intact uterus(35).

b. Side effects are not limit to 
b.1. Headache
b.2. Upset stomach
b.3. Diarrhea Appetite
b.4. Changes in sex drive
b.5. Etc.

3. Antidepressants
3.1. Imipramine 
a. Imipramine is the types of antidepressant used to treat patients with mixed urge and stress incontinence and urinary incontinence associated with spontaneous unstable detrusor contractions. Imipramine was given orally at night to 10 elderly patients with urinary incontinence associated with spontaneous unstable detrusor contractions. The dose was increased for each patient up to a maximum of 150 mg. at night, or until continence was achieved or side effects occurred. Of the 10 patients 6 became continent. In 3 of the 6 patients who underwent repeat cystometry bladder capacity had increased (mean 105 cc), bladder pressure at capacity decreased (mean 18 cm. water) and urethral pressure increased (mean 30 cm. water). There was no correlation between plasma desmethylimipramine and dose, or clinical or urodynamic effect(36).

b. Side effects are not limit to
b.1. The medicine may drug interreaction to certain patients, such as barbiturates, benzodiazepines, etc.
b.2. Agitation and anxiety
b.3. fever
b.4. Convulsion
b.5. Etc.

3.2.. Duloxetine
a. The medication used to treat patient with stress causes of Urinary Incontinence. Dr. Basu M,  and Dr. Duckett JR. at the Medway Maritime Hospital, in the study of Update on duloxetine for the management of stress urinary incontinence, wrote that Duloxetine is a relatively balanced serotonin and noradrenaline reuptake inhibitor (SNRI), which is the first drug with widely proven efficacy to have been licensed for the medical treatment of women with stress urinary incontinence (SUI). Despite favorable results from randomized controlled trials, surgical management continues to be the mainstay of treatment for SUI(37).

b. Side effects are not limit to
b.1. Constipation;
b.2. Decreased sexual desire
b.3. Diarrhea;
b.3. Dizziness and drowsiness
b.4. dry mouth
b.5. Headache
b.6.  Nausea
b.7. Tiredness
b.8. Trouble sleeping
b.9. Etc.

3.3. Etc.

A.4. Medical devices
Certainl medical devices have been used to treat patients with Urinary Incontinence but mostly for women with the diseases.
1. Urethral insert
  Urethral insert is a type of medical device used to protect women against leakage in certain activity, such as certain sport. The device must be removed before urination. In a 5-year ongoing, controlled multicenter study enrolled 150 women. Outcome measures included pad weight tests (PWT), voiding diary (VD), quality of life (QOL) and satisfaction questionnaires with with and without device used, showed that Statistically significant reductions in overall daily incontinence episodes (P<0.001) and PWT urine loss (P<0.001) were observed with the device at all follow-up intervals, and 93% of women had a negative PWT at 12 months. Women were satisfied with ease of use of the device, comfort and dryness, and significant improvements in QOL were observed (P<0.001). Subgroup analysis revealed that the insert was effective, despite the presence of urgency, low LPP, failed surgery and advanced age. AE included symptomatic urinary tract infection in 31.3%, mild trauma with insertion in 6.7%, hematuria in 3.3%, and migration in 1.3% of women. The results of PWT and VD demonstrated device efficacy. Women were satisfied and significant improvements in QOL were observed. AE were transient and required minimal or no treatment. The urethral insert should be considered as an option for the management of SUI. The results of PWT and VD demonstrated device efficacy. Women were satisfied and significant improvements in QOL were observed. AE were transient and required minimal or no treatment. The urethral insert should be considered as an option for the management of SUI(38).

2. Pessary 
a. Pessary is a stiff ring inserted into your vagina and wear all day with female patients with Urinary Incontinence to hold up bladder to prevent leakage. The device present a good option for patients who have not completed childbearing, do not desire surgery, or are poor surgical candidates. Long-term pessary use is a safe and effective option for patients with pelvic organ prolapse (POP) and stress urinary incontinence. Although serious side effects are infrequent, insertion and removal of most pessary types still pose a challenge for many patients. Pessary design should continue to improve, making its use a more attractive option(39).

b. Side effects are limit to
b.1. Vaginal discharge and odor
b.2. Vaginal infection
b.3. Ulceration and erosions
b.4. Bleeding
b.5. Itching and irritation
b.6. Etc.

A.5. Interventional therapies 

Dr, Flanagan L, in the study of Systematic review of care intervention studies for the management of incontinence and promotion of continence in older people in care homes with urinary incontinence as the primary focus (1966-2010), showed that care interventions for the management and promotion of continence, with urinary incontinence as the primary focus, in older care home residents, incontinence is a prevalent and serious problem amongst older people in care homes, with an increasing international focus. MEDLINE and CINAHL searches via OVID (January 1966 to May 2010) were carried out, with studies limited to English language publications only. Included in this search were studies investigating urinary and fecal incontinence in people aged 65 years or older in care homes. Studies on surgical or pharmacological interventions or fecal incontinence alone were excluded. A total of 33 interventional studies were identified. Toileting programs and incontinence pads are the mainstays of treatment, with some studies implying significant economic and labor costs. Drug therapy as an adjunct to toileting programs has so far shown only moderate benefits. Combined physical therapy/behavioral therapies have shown effective short-term improvements. Adaptations to physical environment and staff training techniques might also be paramount. Exercise and Functional Incidental Training programs, although expensive, might provide additional benefit by reducing wetness rates and improving appropriate toileting rates. Combined complex behavioral interventions are now a common feature and their effectiveness for the management of urinary incontinence should be determined in future studies. Studies including long-term effectiveness on maintaining continence with full economic evaluation are also warranted in this population(40). Other direct intervention therapies include
1. Perianal injectable bulking agents 
In the assessment to determine the effectiveness of perianal injection of bulking agents for the treatment of faecal incontinence in adults, showed that Four eligible randomised trials were identified with a total of 176 patients. All trials but one were at an uncertain or high risk of bias. Most trials reported a short term benefit from injections regardless of the material used as outcome measures improved over time. A silicone biomaterial (PTQ), was shown to provide some advantages and was safer in treating faecal incontinence than carbon-coated beads (Durasphere(R)) in the short term. Similarly, there were short term benefits from injections delivered under ultrasound guidance compared with digital guidance. However, PTQ did not demonstrate obvious clinical benefit compared to control injection of normal saline. No long term evidence on outcomes was available and further conclusions were not warranted from the available data(41).

2. Botulinum toxin type A
Botulinum toxin type A is a type of interventional therapy to benefit people with Urinary Incontinence as a result of an overactive bladder.

3. Nerve stimulators
Dr. Findlay JM and Dr. Maxwell-Armstrong C. at the Royal Berkshire Hospital, in the study ofPosterior tibial nerve stimulation and faecal incontinence: a review found that eight studies are discussed in the context of the methodology and underlying neurophysiology of peripheral neuromodulation, as are thus far unanswered questions. The eight studies include a total of 129 patients with faecal incontinence (of variable aetiology), all of whom had failed conservative management. One study was prospective and controlled, six were uncontrolled and one was retrospective and uncontrolled. Five different neuromodulatory protocols were used over six different study periods. Outcome measures varied, but short term primary endpoint success ranged from 30.0% to 83.3%. The limitations to this early evidence, whilst encouraging, are significant, and it remains to be seen whether this novel treatment modality represents the minimally invasive, well-tolerated, cost-effective and flexible panacea hoped for this common and debilitating disease(42).

4. Etc.

A.6. Surgical treatments
Dr. Bergman A and the research team at the University of Southern California Medical Cente, in the study of one hundred seven consecutive patients with clinical and urodynamic findings of genuine stress incontinence not previously treated were prospectively allocated in a randomized manner to one of three surgical procedures: anterior colporrhaphy, revised Pereyra procedure, or Burch retropubic urethropexy, showed that at the 1 year postoperative evaluation Burch procedure stabilized the urethrovesical junction and prevented its descent during straining (evaluated by a postoperative Q-tip test) more effectively than either the Pereyra or anterior colporrhaphy. No procedure resulted in severe postoperative voiding difficulties. The present prospective randomized study demonstrates that in our hands the abdominal retropubic operation for genuine stress incontinence in patients not previously operated on results in a higher cure rate when compared with anterior colporrhaphy or Pereyra procedure(43).

B. In herbal medicine perspective
1.  St John’s wort
In the study to evaluate the effect of St. John’s wort (SJW), an effective and safe herbal antidepressant, on rat bladder contractility, showed that SJW inhibits excitatory transmission of the rat urinary bladder and also directly inhibits smooth muscle contractility. The inhibitory effect on excitatory transmission could involve, at least in part, opioid receptors. SJW may be evaluated for its possible use in treating urinary incontinence in depressed patients(44).

2. Saw palmetto
Saw palmetto is claimed to help treat the symptoms of enlarged prostate, or BPH (benign prostatic hypertrophy). These symptoms include increased nighttime urination and/or decreased urinary flow. There also have been reports of patients using saw palmetto for stomach or intestinal problems, bladder irritation, and bronchitis(45).

3. Green tea 
Green tea drinking is inversely associated with urinary incontinence. In the study to investigate the association between green tea consumption and urinary incontinence among middle-aged and older women, showed that suggested an inverse association between urinary incontinence and habitual green tea consumption in middle-aged and older women(46).

4. Etc.

C. In traditional Chinese medicine perspective(47)
1. Urinary Incontinence in TCM perspective is a result of  the cause of Kidney function disorder. of that canlead to weaken Bladder is strong, leading to other symptoms, such as back pain, neck pain, heel pain, loss of hair, tinnitus, etc.
2. Formula to treat Urinary incontinence: Jing Gui Shen Qi Wan and the ingredients include
a. Radix Rehmanniae Preparata (Shu Di Huang)
b. Fructus Corni officinalis (Shan Zhu Yu)
c. Rhizoma Dioscoreae Oppositae (Shan Yao)
d. Cortex Moutan Radicis (Paeonia Suffruticosa) (Mu Dan Pi)
e. Sclerotium Poriae Cocos (Fu Ling)
f. Rhizoma Alismatis Orientalis (Ze Xie)
g. Cortex Cinnamomi Cassiae (Rou Gui)
h. Radix Aconiti Lateralis Preparata (Zhi Fu Zi)
i. Radix Achyranthis Bidentatae (Niu Xi)
j. Radix Polygoni Multiflori  (He Shou Wu)
k. Fructus Lycii Chinensis (Lycium barbarum)  (Gou Qi Zi)

l. Fructus Schisandrae Chinensis  (Wu Wei Zi)
For the series of Most common Diseases of Ages of 50+, visit http://medicaladvisorjournals.blogspot.ca/p/better-of-living-health-50-over.html

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