Urinary Incontinence

Urinary incontinence is defined as the involuntary loss of urine. Incontinence is 2-3 times more common among women than men, and is primarily related to childbirth and menopause. Urinary incontinence affects 15-30% of women older than the age of 60 and more than 50% of nursing home residents. I. Classification of urinary incontinence

A. Stress incontinence is characterized by involuntary loss of urine occurring with increases in intra-abdominal pressure. Women complain of urinary leakage with cough, exercise, laughing, and Valsalva maneuver. Stress incontinence is caused by urethral hypermobility or intrinsic sphincter deficiency. Urethral hypermobility, the most common cause of stress incontinence, occurs when there is loss of the anatomic support of the bladder neck. This damage to the bladder neck supports may be the result of vaginal delivery or tissue atrophy, resulting from advancing age and estrogen withdrawal. I ntrinsic sphincter deficiency is caused by decreased urethral resting tone. Stress incontinence can occur with advanced pelvic prolapse.

B. Detrusor instability (urge incontinence) is defined as the involuntary loss of urine associated with a sudden and strong desire to void (urgency). Spontaneous uninhibited detrusor overactivity results in detrusor contractions. Patients with this condition complain of an inability to control voiding and experience a sudden urgency to void, which is sometimes unsuppressible. These patients report urinary frequency (>7 times/day), nocturia (>1 time/night), enuresis, and pelvic pain. Although detrusor instability is most often iatrogenic, secondary causes include urinary tract infection, anti-incontinence surgery, bladder stones or foreign bodies, and bladder cancer.

• Immobility/chronic degenerative

• Environmental barriers

disease

• High-impact physical activities

• Impaired cognition

Diabetes

• Medications

• Stroke

• Morbid obesity

• Estrogen deprivation

• Diuretics

• Pelvic muscle weakness

• Smoking

• Childhood nocturnal enuresis

Fecal impaction

• Race

• Delirium

• Pregnancy/vaginal deliv-

• Low fluid intake

ery/episiotomy

Medications Causing Incontinence

Enalapril

Hyoscyamine

Benztropine

Oxybutynin

Trihexyphenidyl

Prazosin

Benzodiazepines

Terazosin

Cisapride

Thioridazine

Furosemide

Chlorpromazine

Hydrochlorothiazide

Haloperidol

Alcohol

Clozapine

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