February 08, 2012
   
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Urinary Incontinence
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Urinary Incontinence

John E. Morley, M.D.
 
Incontinence, the inability to restrain the discharge of urine, is an extremely common and highly treatable disorder. There are two types:
  1. acute, which is often related to an associated disease
  2. chronic persistent incontinence.

Acute Incontinence
Acute incontinence appears suddenly and is not rare in older individuals. It is usually associated with an underlying disease. The causes of acute incontinence are best remembered by the mnemonic, DRIP:
  • Drugs, delirium
  • Retention of urine, Restricted mobility
  • Impaction, Infection
  • Polyuria, Prostatism

The treatment of acute incontinence includes frequent toileting and treatment of the underlying cause. Catheterization should be avoided as it increases the likelihood of hospital-acquired infections.

Chronic Incontinence
The types of chronic incontinence are:
  • Urge incontinence, the most common form of incontinence, is characterized by loss of small or large volumes of urine when the individual has insufficient warning, following the first urge to void, to allow him or her to reach the toilet.
  • Stress incontinence occurs in women who usually have had children and is characterized by loss of small volumes of urine following coughing, sneezing or other maneuvers that increase intra-abdominal pressure. It happens because the internal urethral sphincter, the circular band of muscle that surrounds the bladder opening, has lost muscle tone and pushed outside of the abdominal cavity.
  • Reflex incontinence occurs in persons with spinal cord damage. Their bladders do not receive, via the spinal cord, the message to stop urination.
  • Functional incontinence occurs when either a person's physical or mental state deters the person from urinating in the toilet, i.e., the person lacks the physical ability to reach the toilet or lacks an adequate thought process to go to the toilet when having the urge to urinate. Causes include strokes, dementia and depression.
  • Overflow incontinence is of two types:
    1. Neurogenic - the individual does not receive a message that the bladder is full and a signal to urinate is not transmitted. This occurs in persons with autonomic neuropathy.
    2. Obstructive - prostate enlargement is the usual cause.

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