Urinary Incontinence

Epidemiology: 15% old adults, 50% nursing home residents

Anatomy

Contraction: Bladder (PSNS), internal sphincter (SNS), external sphincter (Pudendal nerve: somaticm via thoracic/lumbar segments)
Sensation  Stretch receptors

Causes

Acute:

DRIP = Delirium, Restricted mobility, Infection/Inflammation/Impaction (faecal), Pharmaceutical

Chronic

• Stress: ♀: pelvic floor, ♂: prostate surgery. Cough. Rx: pelvic floor exercises.
• Urge: detrusor instability: small volume. Rx: regular toileting
• Overflow: prostate, distended bowel. Dribbling, palpable bladder, constipation
• Functional:
• Drugs
• Diuretics, anticholinergics (impair detrusor contraction), sedatives, narcotics, Ca ch blockers, α-adrenergic agonists/antagonists (↑ or ↓ sphincter tone)

Investigation

• Continence record by patient
• Urinalysis
• Renal function, hypergly, hyper Ca
• Post-void USS: incomplete emptying
• XR for stones, constipatient
• Urodynamic tests: necessary before surgery

Treatment

1. Conservative: Beds near toilet. Regular toileting. Pelvic exercises. Bladder retrainin
2. Medical: Review drugs. Catheter
3. Surgical procedures