Note: I copy the "definition" of something straight from the book. I find it's best to have an all-encompassing definition in order to better orient myself when I am studying.
Urinary incontinence (UI) is the involuntary loss of urine severe enough to have unpleasant social or hygienic consequences. UI is diagnosed primarily on history; inquire about UI at every interview. UI is a symptom of an underlying disease process in most cases; some cases are reversible with appropriate treatment.
Incontinence is not considered a part of normal aging. Morbidity related to incontinence includes urinary tract infections (UTIs), indwelling catheters, falls/ fractures, sleep interruption, social withdrawal, and depression.
Successful toileting depends on ready access to facilities, motivation to remain dry, mobility and manual dexterity, and the cognitive ability to recognize/react to the urge to void.
UI can be divided into the following categories:
functional, urge, overflow, stress, and mixed.
Each category has a unique etiology, pathophysiology, symptoms, and management.
- Up to 10% of Canadians have it
- Day continence achieved by 4 years
- Night continence by 5 - 7 years
- More common in women and the elderly
Can be caused by physiologic, structural, or pathologic factors.
- Functional: Cannot reach bathroom due to impaired mobility.
- Urge: Cannot control urge to empty once sensation of fullness is present. Caused by:
- Detrusor hyperactivity or hyperreflexia which may be associated with:
- LUT disorders, such as tumors, stones, uterine prolapse, cystitis, urethritis, impaired bladder contractility.
- CNS disorders such as:
- Stroke, dementia, Parkinson's, spinal cord injury, and normal pressure hydrocephalus.
- Overflow: Bladder inappropriately distended. Caused by:
- Anatomic/Structural abnormalities associated with:
- Enlarged prostate, pelvic prolapse, acontractile bladder (diabetes), MS, spinal cord injury.
- Stress: involuntary leakage d/t maneuvers that increase intra-abdominal pressure.
- Most often caused by prostrate surgery in men, multiparous women.
- Mixed: Mixed.
There is a very long list of predisposing factors, they are listed directly from the book (below), but these are few I want to remember for the test:
(Full list - click to expand)
- Menopause. Why? (Click to expand)
- Increased parity.
- Medication Side Fx.
- Age for both males and females.
- Female: 85% of cases are in women.
- Increased parity.
- Previous genitourinary (GU) surgeries (e.g., prostate surgery, hysterectomy).
- Restricted mobility.
- Chronic illnesses (e.g., diabetes).
- Fecal impactions.
- Excessive urinary output.
- Neurologic disorders (e.g., stroke, spinal cord injury).
- Variety of medications (e.g., antihypertensive medicines, diuretics, sedatives).
- Pelvic trauma (e.g., episiotomy, forceps delivery).
- Sleep apnea.
- High-impact exercise.
- Urinary Sx: urgency, frequency, leakage (via urge or stress), nocturia. (an overactive bladder does not need to be associated with incontinence.)
- Urgency maybe experienced when hearing or touching water, as well as exposure to cold, and rushing to the bathroom.
Other Signs and Symptoms
In addition to urgency/frequency/polyuria (i.e. daytime or nighttime [nocturia] frequency)/incontinence: dribbling, weak (maybe intermittent) stream, incomplete voiding sensation, straining.
- ALL/MEDS/HIITS: (What are HIITS? - Click to expand)
Cannot prescribe antimuscarinic if pt is being treated for glaucoma.
- PMH/FAMHx/OBGYN: inquire if menopausal, fecal incontinence/constipation may suggest retained stool pressing on the bladder.
- SOCHx: Inquire about sexual history.
H&P sufficient to begin treatment.
- UA w/ culture if infection is suspected.
- Urine cytology/cystoscopy if hematuria.
- Post-void residual volume, esp. if neurologic in nature.
- Consider PSA.
Eight reversible causes of transient incontinence can be remembered by using the mnemonic: DIAPPERS.
- Infection (urinary)
- Atrophic urethritis and vaginitis
- Psychological disorders, especially depression
- Excessive urine output
- Restricted mobility
- Stool impaction
- Address funcitonal limitations, caregiver-assisted timed urination, bladder diary to help ascertain cause.
- If overflow, manual emptying or intermittent catheterization.
- Pelvic floor exercises.
- Weight loss
- May need surgical tx: pessary in woman.
- If overactive bladder, anticholinergics/antispasmodics: oxybutynin, tolterodine.
- C/I in narrow-angle glaucoma, urinary retention, gastric retention.
- α-adrenergic antagonists promote urethral contraction.
May refer for hematuria, urodynamic testing (actually the gold standard), gynecology for pessary fitting.
In pregnancy, treated with pelvic floor exercises.
Incontinence in the elderly is a risk for falls !!
In pediatric patients, it presents as enuresis.