Functional Brain Imaging and the Neural Basis for Voiding Dysfunction in Older Adults

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.