- Urinary tract infection (UTI) – inflammation and toxin release irritate the urothelium causing detrusor overactivity
- Faecal impaction – direct pressure on the bladder neck and obstruction of the urethra leads to retention of urine and overflow incontinence. Presence of ‘foreign body’ pressure causes detrusor irritability and urgency
- Medication effects, including polypharmacy – diuretics cause polyuria, which can contribute to urgency incontinence. Anticholinergics/antispasmodics/narcotic analgesics dampen detrusor activity and bowel peristalsis, and may cause urinary retention, faecal impaction and overflow incontinence
Clinical practice note. Drug interactions are common – impact on cognitive status leading to functional incontinence as well as direct effects on the bladder, such as reduced sphincter and bladder tone.
- Delirium – disorientation may impact on ability to find a toilet. Impaired conscious level and reasoning affects abilities to recognise and interpret bladder sensations and desire to void and initiate toilet activities.Voiding mechanisms may be intact but the delirium causes a loss of higher centre control, resulting in inappropriate voiding
- Acute retention – bladder fills to capacity and overflow leakage occurs. Risk of kidney damage increased through ureteric back pressure and reflux
- Depression – mental status may lead to hypomanic condition, where volition and motivation are impaired which can result in voluntary incontinence.Drug treatment of depression may cause urinary retention and reduced sensation, resulting in overflow incontinence, especially where bladder capacity is reduced.
- Atrophic vaginitis/urethritis – thinning of mucosa, dryness and increased friability as a result of decreased oestrogen in women. Causes frequency, burning when passing urine and urgency incontinence.
- Acute exacerbations of illness – heart failure and diabetes may cause polyuria, especially overnight leading to nocturia, urge and stress symptoms. Cough associated with COPD increases stress symptoms.
Understanding Continence Promotion: Effective Management of Bladder and Bowel Dysfunction in Adults
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