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FACTORS COMMENTS IMPLICATIONS FOR MANAGEMENT Diabetes mellitus Poor control can cause polyuria and precipitate or exacerbate incontinence; also associated with increased likelihood of urgency UI and diabetic neuropathic bladder Better control of diabetes can reduce osmotic diuresis and associated polyuria and improve UI Degenerative joint disease Can impair mobility and precipitate urgency UI Optimal pharmacologic and nonpharmacologic pain management can improve mobility and toileting ability Chronic pulmonary disease Associated cough can worsen stress UI Cough suppression can reduce stress incontinence and cough-induced urgency UI Congestive heart failure, lower extremity venous insufficiency Increased nighttime urine production can contribute to nocturia and UI Optimizing pharmacologic management of congestive heart failure, sodium restriction, support stockings, leg elevation, and a late-afternoon dose of a rapid-acting diuretic may reduce nocturnal polyuria and associated nocturia and nighttime UI Sleep apnea May increase nighttime urine production by increasing production of atrial natriuretic peptide Diagnosis and treatment of sleep apnea, usually with continuous positive airway pressure devices, may improve the condition and reduce nocturnal polyuria and associated nocturia and UI Severe constipation and fecal impaction Associated with “double” incontinence (urinary and fecal) Appropriate use of stool softeners
Adequate fluid intake and exercise
Disimpaction if necessary
Neurologic and psychiatric conditions Stroke
Can precipitate urgency UI and less often urinary retention; also impairs mobility UI after an acute stroke often resolves with rehabilitation; persistent UI should be further evaluated
Regular toileting assistance is essential for those with persistent mobility impairment
Optimizing management may improve mobility and improve UI
Parkinson disease
Associated with urgency UI; also causes impaired mobility and cognition in late stages Regular toileting assistance is essential for those with mobility and cognitive impairments in late stages Normal pressure hydrocephalus
Presents with UI, along with gait and cognitive impairments Patients presenting with all 3 symptoms should be considered for brain imaging to rule out this condition, as it may improve with a ventricular-peritoneal shunt Dementia (Alzheimer disease, multi-infarct, others)
Associated with urgency UI; impaired cognition and apraxia interfere with toileting and hygiene Regular toileting assistance is essential for those with mobility and cognitive impairment in late stages Depression
May impair motivation to be continent; may also be a consequence of incontinence Optimizing pharmacologic management of depression may improve UI Medications See Table 2 for more information12,13 Discontinuation or modification of drug regimen Functional impairments Impaired mobility
Impaired cognition
Impaired mobility or cognition due to a variety of conditions listed above and others can interfere with the ability to toilet independently and precipitate UI Regular toileting assistance is essential for those with severe mobility or cognitive impairment Environmental factors Inaccessible toilets
Unsafe toilet facilities
Unavailable caregivers for toileting assistance
Frail, functionally impaired persons require accessible, safe toilet facilities and in many cases human assistance to be continent Environmental alterations may be helpful; supportive measures such as pads may be necessary if caregiver assistance is not regularly available UI—urinary incontinence.
Adapted with permission from the International Continence Society.13
MEDICATIONS EFFECTS ON CONTINENCE α-Adrenergic agonists, including midodrine, clonidine, and phenylephrine Increase smooth muscle tone in urethra and prostatic capsule and may precipitate obstruction, urinary retention, and related symptoms α-Adrenergic antagonists (α-blockers), such as doxazosin, alfuzosin, and tamsulosin Decrease smooth muscle tone in the urethra and may precipitate stress UI in women Angiotensin-converting enzyme inhibitors Cause cough that can exacerbate UI Anticholinergics (see Table 4 in Dyks and Sadowski12) May cause impaired emptying, urinary retention, and constipation that can contribute to UI
May cause cognitive impairment and reduce effective toileting ability
Calcium channel blockers May cause impaired emptying, urinary retention, and constipation that can contribute to UI
May cause dependent edema, which can contribute to nocturnal polyuria
Cholinesterase inhibitors Increase bladder contractility and may precipitate urgency UI Diuretics Cause diuresis and precipitate UI Lithium Polyuria due to diabetes insipidus Opioid analgesics May cause urinary retention, constipation, confusion, and immobility, all of which can contribute to UI Psychotropic drugs Sedatives
Hypnotics
Antipsychotics
Histamine-1 receptor antagonists
May cause confusion and impaired mobility and precipitate UI
Anticholinergic effects
Confusion
Selective serotonin reuptake inhibitors Increase cholinergic transmission and may lead to UI Sodium-glucose cotransporter-2 inhibitors Glycosuria and polyuria, increased propensity to urinary tract infection Others Gabapentin
Glitazones
Nonsteroidal anti-inflammatory agents
Can cause edema, which can lead to nocturnal polyuria and cause nocturia and nighttime UI UI—urinary incontinence.
Adapted with permission from the International Continence Society.13
