Urinary Incontinence

Urinary incontinence (UI) is a common, age-related, involuntary loss of urine.33,34 With aging, bladder capacity decreases, the ability to inhibit urination declines, and detrusor muscle over-activity leads to frequent bladder contractions. In women, decreased estrogen levels lead to decreasing urethral resistance. In men, as prostate size increases, it partially obstructs the urethra. Consequently, voiding becomes difficult to control and tends to become incomplete.

Urinary incontinence is classified as transient or chronic.33,34 Transient incontinence is defined as urinary leaking that spontaneously reverses after the underlying cause such as acute or chronic urinary tract infection, atrophic vaginitis, hyperglycemia, depression, reduced mobility (i.e., functional incontinence), or drug-induced urinary retention is resolved. Chronic incontinence may be characterized as stress-, urge-, mixed-, overflow-, or functional-incontinence.33,34

Stress-incontinence is caused by sphincter weakness. Urge-incontinence is caused by detrusor over-activity, which may be sensory (e.g., local irritation, inflammation, or infection) or neurogenic (e.g., cerebral inhibition of detrusor contractions). Overflow-incontinence is caused by impaired detrusor contractility or bladder obstruction (e.g., BPH) that lead to leakage. Functional-incontinence is usually caused by physical or environmental barriers to use a toilet.

The severity of symptoms and their effect on the quality of life (e.g., effects of UI on work, daily activities, sleep, sexual activity, social interactions) determines treatment.33,34 Treatment begins with bladder training, i.e., relaxation training aimed to reduce detrusor activity.33,34 Drug therapy includes an alpha1‑adrenergic receptor agonist that increase sphincter tone and anticholinergic agents such as solifenacin and tolterodine that relax the detrusor muscle in urge- and stress-incontinence.2,3,34

Some patients with UI may experience near-constant dribbling or intermittent voiding with or without awareness of the need to void. Others may experience extreme urgency with little or no warning and may be unable to prevent voiding until reaching the bathroom. Provide ample opportunities for bathroom breaks during the clinical process. Also, note that opioids cause overflow-incontinence and NSAIDs increase fluid retention causing functional-incontinence.