Incontinence

Reversible conditions associated with Urinary incontinence (DRIIIPP):

• • Delirium

  • Restricted mobility - illnesses, injury, gait d/o, restraint

  • Infection: acute symptoms of UTI

  • Inflammation: atrophic vagnitis

  • Impaction: feces

  • Polyuria: DM, caffeine, volume overload

  • Pharmacy: diuretics, alpha-adrenergic agonists or antagonists, anticholinergics, psychotropics, antidepressants, anti-parkinsonians

Stress incontinence:

• • uretheral sphincter problem

  • sneezing, laughing triggers

Urge incontinence (detrusor overactivity)

• • most common form

  • uncontrollable need to void

  • uninhibited contraction

  • frequently waking up at night to void, and voids >100 mL at a time.

  • DHIC (detrusor hyperactivity with impaired contractility) is a type of urge incontinence where there is involuntary contraction of bladder with a weak detrusor muscle. There is incomplete emptying of bladder.

  • PVR >200 mL:

    • Sterile conditions, straight cath bladder after 5-10 min of voiding. If PVR >200 mL, suggests detrusor underactivity or obstruction - refer to urology.

  • Tx: oxybutinin and tolterodine (anticholinergics) cause bladder relaxation. SE: urine retention, constipation, dry mouth.

Mixed/incontinence: Ask 3 questions:

• • Any leakage in the past 3 mo?

  • Does it sound like sx of urge/stress I?

  • Which type in past 3 mo?

  • Needs urodynamic studies

Overflow incontinence:

• • BOO in BPH, prostate ca, urethral stricture, cystocele

  • Atonic bladder: spinal cord disease, DM autoneuropathy, EtOH, vitamin B12 def, tabes dorsalis, PD

  • Tx: BPH: alpha-adrenergic blocers (terazosin, doxazosin, tamulosin) + 5-alpha reductase (finasteride)

Functional incontinence:

• • Can't make it due to inability to move.