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Urinary Incontinence

Background Info

           Urinary incontinence (UI) is defined as an unconscious/involuntary leakage of urine.  This condition can lead to a significant deterioration in the quality of life and health in some patients such as loss of independence, control, depression, reduced social interactions, psychological stress, dermatitis,  and infections. UI is widespread (affects all age groups) but it is frequently underreported. 1,2,3,4  It is frequently observed in nursing home patients and in the general population with women being twice as likely compared to men to be diagnosed with this condition.   The mechanisms of incontinence are generally related to the urethra sphincter/bladder outlet or the bladder (under /over activity) or a combination of the two. 5,6

Select the option that best describes the condition

Urge Urinary Incontinence (UUI ) or overactive bladder (OAB)

  • Typical symptoms of urinary urge incontinence and bladder overactivity include frequency, urinary urgency (unquestionable desire to void), and moderate to high volume incontinence. 
  • Overactive bladder syndrome:  Urinary urgency +/-  urgency incontinence.  Urinary frequency and nocturia are common.
  • Urinary frequency - usually more than 8 times per day.
  • Nocturia is usually present.


Stress Urinary Incontinence (SUI).  Urethral Under-activity.

  • Complaint of involuntary urinary loss with physical exertion (weight lifting, sprinting, etc.)
  • Generally small amounts of urine released after sneezing, coughing, or other activities that raise intra-abdominal pressure. 
  • Nocturia is not present
  • No urinary loss when resting.



Overflow incontinence  (Chronic Urinary Retention):

  • Urinary incontinence due to excessive bladder volume. 
  •  Increased postvoid residual urine
  • May have considerable obstructive urinary symptoms:
    -decreased force of stream
    -hesitancy
    -lower abdominal fullness
    -straining to void
  • Sensation of incomplete bladder emptying



Functional incontinence

  • Urinary incontinence related to cognitive or mobility deficits. The patient is unable to reach the toilet.  Medications such as  sedative-hypnotics and some surgical procedures  such as hip replacement may lead to functional incontinence.
  • Not caused by bladder or urethra related issues. 


Mixed incontinence

  •  More than one type of urinary incontinence is present.  [Review summaries above]
  • The most common combination is bladder overactivity and urethral underactivity.


Medications and Urinary Incontinence

Agents that may contribute to urinary incontinence - select all drug classes that a patient under review is receiving.

Acetylcholinesterase inhibitors.  Factor(s) impacting urinary incontinence:  Factor(s) impacting urinary incontinence:   frequency, urgency, polyuria.

Alcohol. Factor(s) impacting urinary incontinence:  frequency,  polyuria, urgency, delirium,  sedation

α-Receptor agonists e.g. ephedrine, midodrine, phenylephrine.   Factor(s) impacting urinary incontinence: Urethral constriction and urinary retention in men.

α-Receptor antagonists (e.g., prazosin, terazosin, doxazosin, tamsulosin, silodosin, and alfuzosin).  Factor(s) impacting urinary incontinence:  relaxes the internal bladder sphincter.  Urethral relaxation and stress urinary incontinence in women.

Anticholinergics.  Factor(s) impacting urinary incontinence:  Urinary retention

Antipsychotic agents.   Factor(s) impacting urinary incontinence:  Urinary retention due to anticholinergic effects.

Calcium channel blockers.  Factor(s) impacting urinary incontinence:  Urinary retention.

Diuretics.   Factor(s) impacting urinary incontinence:   frequency, urgency, polyuria.

Opioid analgesics: Factor(s) impacting urinary incontinence: Urinary retention from impaired contractility.

Tricyclic antidepressants. Factor(s) impacting urinary incontinence:  Anticholinergic effects and α-antagonist effects.

References

  1. Abrams P, Cardozo L, Fall M, et al. Standardisation Sub-committee of the International Continence Society. The standardization of terminology of lower urinary tract infection: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002;21(2):167-78.

  2. Berardelli M, De Rango F, Morelli M, et al. Urinary incontinence in the elderly and in the oldest: correlation with frailty and mortality. Rejuvenation
    Res 2013;16:206-11.

  3. Miller DC, Saigal CS, Litwin MS. The demographic burden of urologic disease in America. Urol Clin North Am 2009;36:11.

  4. Townsend MK, Curhan GC, Resnick NM, et al. The incidence of urinary incontinence across Asian, black, and white women in the United States. Am J Obstet Gynecol 2010;202:378 e1-7.

  5. Fowler C. Integrated control of the lower urinary tract—Clinical perspective. Br J Pharmacol
    2006;147(Suppl 2):s14-s24.

  6. Blok BF. Brain control of t he lower urinary tract. Scand J Urol Nephrol Suppl. 2002;(210):11-15.

  7. Cottenden A, Bliss DZ, Buckley B, et al. Management using continence product s. In: Abrams P, Cardozo L, Khoury S. Wein A, eds. Incontinence, 4th ed. Paris, France: Health Publications, Ltd. 2009:1519-1642.

  8. Shamliyan T, W yman J, Bliss DZ, Kane RL, Wilt TJ. Prevention of Urinary and Fecal Incontinence. Prepared by the Minnesota Evidence-based Practice Center under Contract 290-02-0009. Publication No. 08-E003. Rockville, MD: Agency for Healthcare Policy and Research, 2007.

  9. Gormley EA, Lightner DJ, Burgio KL, et al. Diagnosis and treatment of overactive bladder (nonneurogenic) in adults: AUA/SUFU guideline. J Urol 2012;188(6 Suppl):2455-2463.

  10. Gormley EA, Lightner DJ, Faraday M, Vasavada SP, American Urological Association, Society of Urodynamics, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015 May. 193 (5):1572-80.

  11. American College of Obstetricians and Gynecologists. Practice Bulletin No. 155: Urinary Incontinence in Women. Obstet Gynecol. 2016 May. 127 (5):e66-81.

  12. Delancey JO, Ashton-Miller JA. Pathophysiology of adult urinary incontinence. Gastroenterology. 2004 Jan. 126(1 Suppl 1):S23-32.

  13. Wein AJ, Rackley RR. Overactive bladder: a better understanding of pathophysiology, diagnosis and management. J Urol. 2006 Mar. 175(3 Pt 2):S5-10.

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Lab Values - A thru Z

Lab Values - A thru Z