Urinary Incontinence

2 Potentially reversible conditions leading to urinary incontinence: “DIAPERS”: D elirium Urinary infection A trophic vaginitis P harmaceuticals/side effects P sychological condition E xcess fluid in/out—recommend no fluid intake in the evening R estricted mobility S tool impaction Drugs inducing incontinence Clinical effects Alpha-adrenergic agonists Increase smooth muscle tone, urinary sphincter + prostatic capsule increase residual volume—overflow incontinence Alpha-blocker (doxazosin, prazosin, tamsulosin) Relax urinary sphincter and urethra, may cause stress incontinence, e.g. when coughing, lifting objects Angiotensin-converting enzyme inhibitors Can worsen stress incontinence by inducing repetitive coughing Anticholinergic drugs May cause impaired emptying, urinary retention, infection, constipation, reduce effective toileting ability, dizziness, confusion, falls, dry eyes, dry mouth and induce increase fluid intake, dose-dependent effect Calcium channel blockers Smooth muscle relaxants, may cause impaired emptying, urinary retention (overflow incontinence) and constipation Cholinesterase inhibitors Increase bladder contractility/urgency UI (dose-dependent effect) Diuretics—furosemide, thiazide Increase urine production—symptoms of urinary urgency increase Gabapentin Oedema, nocturnal polyuria Lithium Polyuria due to diabetes insipidus Opioids/morphine May cause urinary retention, constipation, confusion, immobility, all of which can contribute to UI Sedatives, hypnotics, antipsychotics Anticholinergic side effects: confusion, dizziness, immobility, decreasing detrusor contractility—urinary retention Selective serotonin reuptake inhibitors Increase cholinergic activity—and bladder contractility