Urinary incontinence

What it is

Urinary incontinence is the loss of bladder control, often beginning with urinary urgency and frequency and progressing to incontinence. It is one of the classic triad of normal pressure hydrocephalus (NPH), alongside gait and cognitive symptoms.

Understanding Urinary incontinence

In NPH, bladder symptoms typically appear after gait disturbance and often after cognitive changes, completing the triad sometimes remembered as "wet, wacky, and wobbly." The incontinence in NPH is thought to relate to the effects of enlarged ventricles on nearby brain pathways controlling the bladder. Because urinary incontinence is common in older adults for many reasons, it is interpreted as part of the overall NPH picture rather than in isolation. With treatment (a shunt) in well-selected patients, bladder symptoms may partly improve, though, like cognition, often less reliably than gait. The bladder symptoms are assessed as part of evaluating NPH.

Why it matters

Understanding urinary incontinence as part of the NPH triad helps families see how bladder symptoms fit into the picture of NPH, and that they, too, may partly improve with treatment in selected patients.