TOC |  Kidney
Urinary Incontinence    

Types of Urinary Incontinence:

• Genuine stress incontinence
• Urge incontinence (overactive bladder)
• Mixed incontinence
• Overflow incontinence
• Bypass of anatomic mechanism
• Functional incontinence
• Transient causes

Causes of Stress Urinary Incontinence:

• Vaginal birth
• Forceps delivery
• Aging
• Obesity
• Race
• Connective tissue disease
• Menopause
• Hypo-estrogenism

Reversible Causes of Urin-Incontinence:

• Delirium
• Infection (symptomatic urinary tract)
• Atrophy (urogenital)
• Pharmacologic
• Psychologic
• Excess fluid excretion
• Restricted mobility
• Stool impaction

Drugs Causing Urin-Incontinence:

• Calcitonin (Calcimar); Cisapride (Propulsid); Cyproheptadine (Periactin); Doxorubicin (Adriamycin); Edrophonium (Tensilon); Fluoxetine ; (Prozac),  Paroxetine (Paxil), Sertraline (Zoloft); Furosemide (Lasix), Hydrochlorothiazide; Gabapentin (Neurontin); Leuprolide (Lupron); Omeprazole (Prilosec); Prazosin (Minipress); Protriptyline (Vivactil); Bromocriptine (Parlodel); Captopril (Capoten); Demecarium (Humorsol); Felbamate (Felbatol); Guanfacine (Tenex)

Drugs Causing Urinary Retention:

• Dicyclomine (Bentyl); Disopyramide (Norpace); Hyoscyamine (Levsin); Isoproterenol (Isuprel); Methantheline (Banthine); Nifedipine (Procardia); Orphenadrine (Norflex); Oxybutynin (Ditropan); Paroxetine (Paxil); Trazodone (Desyrel)

Overactive Bladder Symptoms:

• Frequency, Urgency, Nocturia, Urge Incontinence

Causes of Overactive Bladder Syndrome:

1. Medication
   • Parasympathomimetics
   • Diuretics
2. Bladder/urethral irritation
   • Cystitis
   • Foreign bodies
3. Outflow obstruction
   • Tumors
   • Genitourinary prolapse
4. Metabolic factors
   • Diabetes
   • Polydypsia
5. Neurologic disease
   • Multiple sclerosis
   • Cerebrovascular disease
   • Parkinsonism
   • Alzheimer’s disease
6. Idiopathic

Incidence of Overactive Bladder Syndrome:

• Premenopausal 5-10%
• Postmenopausal 38%
• Institutionalized elderly women 50%

Initial Evaluation of Urin. Incontinence:

• Detailed history
• Standing cough stress test
• Postvoid residual
• Urinalysis, culture & sensitivity
• Physical examination
• Pelvic relaxation
• Neurologic exam
• Simple cystometry

Management of Urin. Incontinence:

• Treat reversible causes of incontinence
• Behavioral modification
  Oral Intake Modification
  Timed Voiding
  Prompted Voiding
  Urge Suppression
• Pelvic floor rehabilitation
  Kegel Exercises
  Biofeedback
  Functional Electric Stimulation
• Pharmacotherapy
  Drug                                          Action                                         Dosage
  OXYBUTYNIN                Musculotropic relaxant,                       Ditropan 2.5 - 5 mg PO TID
                                               Local anesthetic,                              Ditropan XL 5 - 30 mg PO QD
                                               Anticholinergic  
  HYOSCYAMINE              Antispasmodic, Anticholinergic           Levsin .125 - .25 mg PO QID
  TOLTERODINE              Anticholinergic                                      Detrol 1 - 2 mg PO BID
                                                                                                       Detrol LA 4 mg PO QD
  IMIPRAMINE                     Tricyclic Antidepresent                      Tofranil 25 - 50 mg PO BID
  
  Vaginal estrogen cream or Estring
  No proven efficacy for urinary incontinence
  Urogenital atrophy
• Surgical treatment