Incontinence

Incontinence

Any involuntary loss of urine which objectively demonstrable and a social or hygienic problem – Incontinence is NEVER normal!

The Audio

The Scale of The Problem

3-6 million people suffer from urinary incontinence (UI) in UK. 60-80% has never sought help; people don’t admit to continence problems. It isthree times more common in women than men. 

For those age >80 years, 46% of women and 34% of men suffer from UI.

Medical Complications:

  • UTI

  • Pressure ulcers (due to moisture)

  • Falls and fractures

  • Rashes (e.g. Incontinence associated dermatitis)

Psychological Complications:

  • Embarrassment

  • Stigmatisation

  • Isolation/Depression

Basics of Bladder

  • Capacity: 400-600 mls. Average void volume: 250-400 mls

  • Residual urine (post void): 0 ml (up to 200 mls in older people)

  • Micturition reflex: autonomic nervous systems (sympathetic/parasympathetic) runs between bladder and pontine micturition centre in brainstem via lower spinal cord.

Persistent Urinary Incontinence

  1. Overactive Bladder syndrome (urge incontinence): most common type (~70%), inability to delay voiding due to detrusor (bladder) muscle instability. Commonly seen in stroke, dementia, Parkinsonism, MS, and spinal cord injury.

  2. Stress Incontinence syndrome: increase in intra-abdominal pressure (ex; cough, laugh, exercise) causes incontinence due to weakness of pelvic floor muscles.

  3. Bladder Outlet syndrome (overflow incontinence): dribbling/continuous leakage with incomplete bladder emptying due to obstruction (prostate enlargement, faecal impaction)

  4. Mixed syndrome: mixture of 1 & 2 above

  5. Continual Incontinence syndrome: Fistula between bladder and vagina

  6. Functional – inability to get to the toilet in time, for example because of arthritis

Discussion Points

After conservative measures, such as fluid intake, avoiding caffeine, bladder training, pelvic floor exercise, Tension-Free Vaginal Tape surgery is a relatively minor and accessible operation for Stress Incontinence syndrome.

For people with RECURRENT UTI, look out for

  1. Atrophic vaginitis

  2. Constipation

  3. Do post-void bladder scan.

ED Pitfalls:
  • Do not give prophylactic antibiotics without assessment!
  • Don't assume it is not an ED problem: it's the consequences such as UTIs and falls. Let's stop them before they happen!
Adapted from the Acute Frailty Inter-Professional Education Session 6th May 2016
Edit and Peer review by Jamie Sillett
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