Just as Donguibogam emphasized the interactions between organs and the effects of stress centuries ago, modern medicine also interprets urinary incontinence not as simple urinary bladder dysfunction, but as a complex problem involving the brain, nervous system, hormones, and muscles. In particular, stress urinary incontinence, which occurs when intra-abdominal pressure increases during events like coughing or laughing, is a clear example of these complex interactions breaking down.
The most direct cause is the weakening of the pelvic floor muscles that support the urinary bladder. These muscles support the urinary bladder, uterus, and rectum like a hammock, and are responsible for tightening the urethra and anus. When these muscles weaken due to childbirth, aging, chronic cough, constipation, or other factors, they cannot tighten the urethra sufficiently when intra-abdominal pressure is applied, leading to urine leakage. This aligns directly with visceroptosis caused by the sinking of spleen qi described in Donguibogam.
However, this is not the entire picture. As the name stress urinary incontinence suggests, the impact of psychological stress on urinary bladder function is also well established scientifically. The brain acts as an important command center regulating the urine storage and voiding functions of the urinary bladder. The autonomic nervous system is particularly central: the sympathetic nerve controls urine storage, while the parasympathetic nerve regulates urine expulsion. Chronic stress keeps the body continuously in a state of sympathetic hyperactivity. During this state, stress hormones such as cortisol are secreted excessively, which can increase the irritability of the urinary bladder muscle or impair the function of the sphincter that tightens the urethra. This can prevent the urinary bladder from emptying completely or make it difficult to hold urine even under minimal pressure.
Furthermore, stress affects the brain-bladder axis. Under stressful conditions, frontal lobe function declines, which can weaken the ability to appropriately suppress urinary bladder signals. Consequently, the brain fails to respond properly to the signal from the urinary bladder indicating a need to urinate, or it responds overly sensitively, causing an urgent desire to urinate even when the urinary bladder is not actually full. Just as Donguibogam observed that liver qi stagnation blocks the circulation of qi and blood to impair urinary bladder function, modern medicine explains that stress disrupts the balance of neurotransmitters and hormones in the brain, interfering with the delicate regulatory function of the urinary bladder.
Ultimately, remember that urinary incontinence is not merely a problem of a weak urinary bladder or weak muscles, but a comprehensive health signal encompassing the brain, nerves, hormones, and emotional state. While it appears more commonly in women who are aging or have experienced childbirth, it can also affect anyone experiencing severe stress, even at a young age. It should not cause shame, and it can be managed prudently.
