Urinary Incontinence

• Risk factors for UI

  • Women
  • Pregnancy
  • Child birth
  • Menopause
  • Pelvic surgery
  • Men
  • Benign prostatic hyperplasia
  • Prostate surgery
  • Non-Gender Specific
  • Smoking
  • Obesity
  • Constipation
  • Stroke
  • Parkinson's Disease
  • Dementia
  • Alzheimer's disease
  • Multi-infarct dementia
  • Congestive heart failure
  • Sleep apnoea
  • Depression
  • Behavioural disorders
  • Diabetes (polyuria, polydipsia, neuropathy)
  • Spinal Injury
  • Multiple Sclerosis
  • Age-related changes
• Age-related changes


  • Elastin reduces bladder capacity
  • Delayed sensations from bladder
  • ↓ ability to postpone urination
  • Incomplete emptying & ↑ residual volume
  • ↓ flow rate
  • ↑ number of involuntary bladder contractions (detrusor instability)
  • ↓ pelvic support muscle strength
  • Atrophic changes postmenopausal
• Types of UI


  • Stress urinary incontinence
  • Urge urinary incontinence
  • Overflow urinary incontinence
  • Functional incontinence
  • Mixed incontinence
• Stress urinary incontinence


  Involuntary leakage on effort or exertion
• Stress urinary incontinence

  • The uncontrollable loss of small amounts of urine when: coughing, Straining, sneezing, lifting heavy objects, or performing any manoeuvre that suddenly increases pressure within the abdomen
  • It is not caused by emotional stress
  • Stress incontinence is the most common type of UI amongst young and middleaged women
  • Caused by weakness of urinary sphincter or pelvic floor
  • Factors contributing to these include: Childbirth, Pelvic surgery, (e.g. prostatectomy in men), Abnormal anatomical position of the urethra or uterus., Lack of oestrogen (e.g. as in postmenopausal women), Obesity
• Urge urinary incontinence

  • Involuntary leakage preceded by urgency
  • Urine loss, accompanied by or immediately preceded by urgency
  • Sudden compelling desire to pass urine which is difficult or impossible to defer
  • Common in the elderly
  • Often no clear cause
  • Worsened by diuretics
  • Often in combination with other forms of UI
  • In most older people with urge UI, bladder muscles are overactive ('overactive bladder')
  • Bladder muscles contract involuntarily before the bladder is full
• Overflow urinary incontinence

  • Now referred to as "chronic retention of urine"
  • Emptying failure by outlet obstruction or inability to contract detrusor
  • Uncontrollable leakage of small amounts of urine from a bladder that does not empty well
  • Due to urinary retention or underactive bladder
  • Outflow blockage causes: Enlarged prostate, Constipation, which may be drug related e.g. Anticholinergics, Opioids, Neurogenic bladder e.g. diabetes
• Functional incontinence

  • Lack of recognition or ability to get to toilet in time
  • Loss of urine due to inability and/or unwillingness to go to the toilet
  • Associated with Immobility e.g. arthritis, stroke, Loss of mental function e.g. dementia
• Mixed incontinence

  • A combination of the above types of UI
  • Many patients do not fit neatly into one of the various categories of UI
  • Often a variety of causes, e.g. overlapping stress, urge and functional UI
  • Such patients may be described as having mixed urinary incontinence
  • Can complicate management
• Management of stress urinary incontinence

  • Review patient's medications
  • Pelvic floor exercises
  • Treat constipation
  • Treat chronic cough
  • Weight loss
  • Adrenergic agonists – Pseudoephedrine, Terbutaline
  • Duloxetine - A serotonin-norepinephrine reuptake inhibitor (SNRI) that can increase urethral sphincter muscle tone
  • Vaginal oestrogens
• Management of urge incontinence

  • Exclude UTI
  • Treat constipation/impaction
  • Review patient's existing medications
  • Reduce caffeine and alcohol
  • Bladder training
  • Trial anticholinergic drug therapy
  • Invasive therapies e.g. botulinum toxin injections
  • Anticholinergics
  • Botulinum toxin
• Management of overflow urinary incontinence

  • Review Medications
  • If BPH is the cause-treat BPH (e.g 5-alpha reductase inhibitors)
  • Catheterisation
  • Surgery e.g TURP
  • Alpha-Blockers: Medications like tamsulosin that relax the muscles of the bladder neck and prostate to improve urine flow
• Management of functional incontinence

  • Regular toileting assistance
  • Reminders/scheduled voiding
  • Pads/garments may be useful but important to try and avoid reliance on them
• Drugs that can adversely affect UI

  • Diuretics
  • Alpha-Adrenergic Agonists
  • Anticholinergics/Antimuscarinics
  • Alpha-Blockers
  • Antidepressants
  • Antipsychotics
  • Opioids
  • Calcium Channel Blockers
  • ACE Inhibitors
  • Sedatives and Hypnotics
• Diuretics


  Increase urine production, leading to a higher frequency and urgency of urination, potentially worsening incontinence
• Alpha-Adrenergic Agonists


  Increase urethral sphincter tone, which can worsen overflow incontinence or cause urinary retention
• Anticholinergics/Antimuscarinics


  Relax the bladder, which can lead to urinary retention and overflow incontinence
• Alpha-Blockers


  Relax the bladder neck and prostate muscles, which can exacerbate stress incontinence, especially in women
• Antidepressants


  Some antidepressants with anticholinergic properties can cause urinary retention, while others, like duloxetine, may improve stress incontinence by increasing urethral sphincter tone
• Antipsychotics


  Can cause urinary retention due to their anticholinergic effects, leading to overflow incontinence
• Opioids


  Can cause urinary retention by reducing bladder muscle activity, leading to overflow incontinence
• Calcium Channel Blockers


  Can cause urinary retention by relaxing the bladder muscle
• ACE Inhibitors


  Can cause a chronic cough, which may worsen stress incontinence due to increased intra-abdominal pressure
• Sedatives and Hypnotics


  Can cause confusion and reduced mobility, leading to functional incontinence
• How nurses can help with UI

  • Collect history, investigations and examinations, determine type, treat reversible causes
  • Primary health - access point of contact for advice/concern
  • Confidential/empathy/Privacy
  • Education/training
  • Fluid/dietary management
  • Timed voiding
  • Urge inhibition
  • Positive reinforcement
  • Pelvic muscle training (Kegel)
  • Voiding diary
  • Review patient medications
  • Referral to appropriate services
  • Awareness of the impact of the condition
  • Find your nearest toilets
• Drugs that can worsen UI

  • Oxybutynin
  • Prazosin
  • Furosemide
  • Metoprolol
  • Perindopril
  • Spironolactone
  • Paracetamol/codeine
  • Amitriptyline
• Oxybutynin


  Reduces detrusor muscle contraction and can worsen overflow incontinence due to urinary retention. Can also contribute to his fall through sedation
• Prazosin


  Is an alpha blocker that can help overflow incontinence by reducing lower urinary tract symptoms such as urgency, frequency. However, it can cause postural hypotension and may have contributed to his fall
• Furosemide


  Can worsen UI by virtue of its diuretic effect. Can reduce BP and may have contributed to his fall
• Metoprolol


  No effect on urinary function. However, can reduce BP and may have contributed to his fall
• Perindopril


  No effect on urinary function. Can cause cough and worsen stress incontinence in some patients. Can reduce BP and may have contributed to his fall
• Spironolactone


  Can worsen UI due to its diuretic effect even though considered a weak diuretic. Can reduce BP (although not significantly)
• Paracetamol/codeine


  Can worsen stress UI as it can cause constipation. It can also worsen functional incontinence and contribute to fall by causing sedation
• Amitriptyline


  Can worsen overflow UI due to anticholinergic side effects. Can worsen functional incontinence through sedation. It can cause postural hypotension through its alpha blocking action which may have contributed to his fall