Urinary Incontinence
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Background Info
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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
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Select the option that best describes the condition
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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.
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Medications and Urinary Incontinence
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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.
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References
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- 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.
- 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.
- Miller DC, Saigal CS, Litwin MS. The demographic burden of urologic
disease in America. Urol Clin North Am 2009;36:11.
- 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.
- Fowler C. Integrated control of the lower urinary tract—Clinical
perspective. Br J Pharmacol
2006;147(Suppl 2):s14-s24.
- Blok BF. Brain control of t he lower urinary tract. Scand J Urol
Nephrol Suppl. 2002;(210):11-15.
- 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.
- 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.
- 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.
- 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.
- American College of Obstetricians and Gynecologists. Practice
Bulletin No. 155: Urinary Incontinence in Women. Obstet Gynecol. 2016
May. 127 (5):e66-81.
- Delancey JO, Ashton-Miller JA. Pathophysiology of adult urinary
incontinence. Gastroenterology. 2004 Jan. 126(1 Suppl 1):S23-32.
- 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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