Incontinence and sexual dysfunction

This chapter discusses urinary and fecal incontinence, impotence-the most common sexual impairment caused by neurological disorders-and their central nervous system (CNS) substrates. Fecal and urinary incontinence and genitourinary dysfunction are a costly healthcare problem that can be caused by lesions at several levels of the nervous system, in association with a variety of medical, neurologic, and psychiatric diagnoses. Key symptoms range from incontinence and impotence to sexual aberration. Patients with erectile dysfunction have several options for treatment including devices, oral, intraurethral or intracavernosal agents, or surgery. Pharmacologic therapy seems to benefit patients with detrusor instability. Surgical treatments for urge incontinence due to neurogenic and idiopathic detrusor overactivity are similar in men and women. Colostomy is an established surgical option typically reserved for patients with fecal incontinence refractory to multiple other treatment options.