RespiteMatch.com Health Blog

Acute (or Transient) Incontinence is caused by a new or recent medical problem that can be treated. Medical conditions such as dehydration, delirium, urinary retention, fecal impaction/constipation, urinary tract infection and atrophic vaginitis can cause an onset of UI. If one of these problems is identified, treatment to correct the problem should be started. Once the medical problem causing the acute incontinence is resolved, the incontinence should improve. In addition to medical problems, certain medications can cause or contribute to an incontinence problem. An easy acronym used to remember these causes is the word DRIP. The breakdown of this word is as follows:

D = Delirium, Dehydration, Diapers.
R = Retention, Restricted Mobility.
I = Impaction, Infection, Inflammation.
P = Pharmaceuticals, Polyuria, Paget’s Disease.

Table 1

This table explains medical conditions that can cause acute incontinence.

MEDICAL PROBLEMS THAT CAUSE INCONTINENCE CAUSE REASON
Fecal Impaction Stool (feces) can block the outflow of urine and cause urinary retention. Persons with fecal impaction complain of either urge or overflow incontinence and may have fecal incontinence as well.
Infection Dysuria, urgency and irritation from a bladder infection may cause or worsen urge incontinence.
Atrophic Vaginitis/Urethritis A decrease in the estrogen hormone in women causes atrophic (loss of firmness in the tissue) changes in the vagina and around the urethra. The inflammation (swelling) which results from this lack of estrogen can cause urge and stress UI symptoms.
Large amounts of urine production (e.g. uncontrolled diabetes mellitus, hypercalcemia Large amount of fluid intake or medical conditions that lead to increased output (e.g., hypercalcemia (high calcium levels), hyperglycemia (high sugar levels), and diabetes insipidus), and in persons with congestive heart failure, leg edema (swelling), vein insufficiency, can lead to incontinence by rapid and excessive filling of the bladder. Increased sugar levels in the bladder can cause irritation of the bladder muscle and can lead to UI.
Urinary Retention (incomplete bladder emptying) Urine leakage can occur because of large amounts still in the bladder after voiding.
Restricted Mobility (decreased ability to walk around) Decreased or limited mobility can cause incontinence and can frequently be corrected or improved by treating the underlying problem (e.g., arthritis, poor eyesight, Parkinson’s disease, or orthostatic hypotension).

MEDICATIONS THAT CAN CAUSE UI MEDICATION
EFFECT ON LOWER URINARY TRACT

Diuretics (water pills) Diuresis induced by diuretics may precipitate incontinence. This is particularly relevant in older persons and/or in those with already impaired continence.
Sedatives (sleeping pills), Hypnotics CNS Depressants Benzodiazepines, especially long-acting agents such as flurazepam and diazepam (Valium), may build up in the bloodstream of an older person and cause confusion and alter the persons ability to recognize the urge to void and lead to UI.
Alcohol Alcohol can alter memory, impair mobility, and cause increased urine output, resulting in incontinence. In addition, it has a sedative effect that may alter a person’s awareness of the need to void.
Anticholinergic agents: Antihistamines, Antidepressants (TCA), Phenothiazines, Disopyramides, Opiates, Antispasmodics, Parkinson drugs, Alpha-adrenergic agents Prescription as well as over-the-counter drugs with anticholinergic properties are taken commonly by persons with insomnia, pruritus (itchy skin), vertigo (dizziness), and other symptoms or conditions. Side effects include urinary retention with associated urinary frequency and overflow incontinence. Besides anticholinergic actions, antipsychotics such as thioridaxine and haloperidol (Haldol) may cause sedation, rigidity (stiffness), and immobility.
Alpha-adrenergic agents (high blood pressure drugs)
Sympathomimetics (decongestants), Sympatholytics (e.g., prazosin, terazosin, and doxazosin)
Alpha-adrenergic stimulation increases urethral tone and alpha-adrenergic block reduces it. Alpha-agonists may cause urinary retention symptoms in older men. Stress incontinence may become symptomatic in women treated with alpha-antagonists as antihypertensive therapy. Older men with a large prostate may develop acute urinary retention and overflow incontinence when taking multicomponent “cold” capsules that contain alpha-agonists and anticholinergic agents, especially if a nasal decongestant and a nonprescription hypnotic antihistamine are added.
Calcium channel blockers (heart & blood pressure medications) Calcium channel blockers can reduce smooth muscle contractility in the bladder and occasionally can cause urinary retention and overflow incontinence.

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Chronic Urinary Incontinence
There are basically four kinds of chronic urinary incontinence: Stress, Urge, Overflow, and Functional incontinence. They may occur alone, as is usually the case in the young adult, or in combination, as seen the elderly.

Stress Incontinence
Stress incontinence is the involuntary leakage of small amounts of urine in response to increased intra-abdominal stomach pressure. Incontinence occurs during physical exertions when you sneeze, cough, laugh, or lift heavy objects. Stress incontinence is seen predominantly in women and is present in about 35 percent of incontinent elderly persons. The pelvic muscle is the key muscle in the pelvis that controls urine loss during increases of intra-abdominal pressure. Stress incontinence results from either weakened support of the pubococcygeus and levator ani muscle and other pelvic structures or sphincter weakness/damage. Increasing levels of two neurotransmitters, serotonin and norepinephrine, found in the sacral spinal cord (Onuf’s nucleus) can lead to an increased contraction of the external urethral sphincter. A new medication called duloxetine contains these neurotransmitters and will be the next treatment for stress incontinence. Typically, this type of incontinence occurs in women in whom childbirth caused a relaxation of the pelvic and periurethral musculature. It also occurs in men who have undergone prostate surgery and have lost function of the urethral sphincter that surrounds the prostate.

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Urge Incontinence
Urge incontinence is the leakage of larger amounts of urine that occurs when a person is not able to reach the toilet after the urge to void is perceived. Complaints include urine loss on the way to the bathroom or “key in the lock” syndrome. This type of incontinence is part of the diagnosis of overactive bladder. Overactive bladder is a combination of urinary urgency, frequency and urge UI. Urge incontinence is the most common (60-70%) pattern of UI in the older person. Detrusor instability, sometimes called “overactive bladder”, also occurs with urge incontinence and is associated with disorders of the lower urinary tract or neurologic system. Urge incontinence can be the result of several causes which include detrusor hyperreflexia (unstable bladder), tumors, stones, or diverticula. Since urge incontinence can result from an urologic carcinoma, any asymptomatic hematuria must be referred for further evaluation. Persons with symptoms of urge incontinence may also have a condition which is called detrusor hyperactivity with impaired bladder contractility (DHIC). These clients will strain to void and have urinary retention. Treatments for urge incontinence include drug therapy and behavioral interventions.

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Overflow Incontinence
Overflow incontinence accounts for 10-15% of urinary incontinence. Overflow leakage of urine occurs when there is a mechanical or functional obstruction of the urinary bladder outlet. The obstruction leads to overfill of the bladder and incontinence due to a detrusor contraction which occurs when a certain volume is reached. In this form of chronic incontinence, the client usually does not know why she/he leaks urine and frequent dribbling is common. Often the sensation of bladder fullness is diminished and the stream of urine is weak. These symptoms occur secondary to an anatomic obstruction (i.e. enlarged prostate, urethral stricture) or an atonic bladder. An atonic bladder can result from neurologic injury, diabetic neuropathic bladder, or drug-induced atonia. Drug induced atonia can be caused by anticholinergics, narcotics, anti-depressants, and smooth muscle relaxants. Neurologic injury can be caused by spinal cord trauma or a stroke.

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Functional Incontinence
Functional incontinence may occur after a major illness or in nursing homes. It accounts for 25% of the incontinence seen in hospitals and results when a person has difficulty moving from one place to another. Sensory impairments (including poor vision, hearing, or speech which may influence success in reaching facilities and inability to notify caregivers of the need to use the bathroom) can cause functional incontinence. The person’s home environment, such as a readily accessible bathroom, may cause incontinence. Usually the person complains that she/he “cannot hold my urine until I can get to the bathroom”. This is usually due to decreased mental function, decreased functional status, and/or unwillingness to go to the toilet.

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December 2003