Types of Incontinence

  Acute or Transient

  Chronic or Persistent

Urinary incontinence can be classified as acute or transient, and chronic or persistent. You can also think of transient incontinence as a temporary, treatable, and reversible problem. The onset of transient incontinence can be correlated to an acute illness or exacerbation of a medical problem.

This mnemonic from Dr. Neal Resnick is helpful to use when we are conducting our individualized assessment of a patient/resident with new onset incontinence. Before ordering a bag of adult briefs, evaluate to see if any of these factors contributed to the onset of incontinence. Identification of one or more of these factors can result in prompt resolution of the problem. This is a list of frequent reversible causes of incontinence.

  Delirium

  Infection

  Atrophic Vaginitis

  Pharmaceuticals, Psychological

  Excessive urine output

  Restricted or decreased Mobility

  Stool Impactions

In addition to delirium, dehydration can contribute to incontinence. As the urine becomes more concentrated, this irritates the urethra and bladder causing increased frequency and incontinence. Hydrating the patient will usually resolve the incontinence. Pharmaceuticals that can contribute to incontinence include: diuretics, ACE inhibitors, Calcium Channel blockers, sedatives, hypnotics, and anti-cholinergics to name a few--so check the patient’s/resident’s medication administration record and consult with your pharmacist. And don’t forget to look at caffeine and alcohol use. Conditions like hyperglycemia, heart failure, hypercalcemia and venous insufficiency contribute to increased urine production. Constipation and/or fecal impaction can contribute to urinary retention and urinary incontinence as well.

 

Persistent Urinary Incontinence

Persistent or chronic urinary incontinence can be classified in the following ways. Knowing what type of incontinence a patient has provides us with useful information related to the timing of the incontinent episode as well as any precipitating factors prior to the episode. Knowing the type can also help to quantify the amount of urine lost. These, in addition to other assessment findings, such as mobility and activity level, mental status, and past medical and surgical histories helps us select the most appropriate and cost-effective management products.

  Functional

  Stress

  Urge or Overactive Bladder

  Mixed

  Overflow

Functional incontinence occurs when a person is unable, or in some cases unwilling, to use the toilet. It happens as a result of having a condition that impacts the person’s ability to get around. This may be related to joint problems like arthritis, problems with gait and balance, fractures, muscle weakness and dementia. Sometimes, we as caregivers cause functional incontinence. Many years ago (pre-OBRA-87), a 76 year old woman was hospitalized for pneumonia. She was receiving IV fluids at 125cc/hr and some IVPB antibiotics. She also received some IVP Lasix. Her side rails were up and her call light was across the room. Is it any wonder that when the nursing assistant  heard her calling that her bed was already wet?

Stress incontinence is a problem with the urethra and the sphincter. Usually, small amounts of urine are lost when there is a sudden increase in intra-abdominal pressure which occurs with sneezing, coughing, lifting or getting out of bed. The pelvic floor muscles and sphincters may become weak or damaged by giving birth, straining to move one’s bowels due to constipation, or with declining estrogen levels.

Urge or overactive bladder is associated with the “gotta go right now” phenomena. Moderate to large amounts of urine may be lost at one time and associated symptoms include frequency, nocturia and urgency. For some, a trigger precedes the strong urge to void. This may include: putting a key in the front door lock, hearing water running, or washing dishes. OAB occurs when the bladder muscle has uninhibited, involuntary contractions when the bladder is filling, which forces the urine into the urethra. The person is unable to inhibit these contractions which results in urine loss.

Mixed incontinence is a combination of both stress and urge symptoms with variable amounts of urine lost.

Overflow incontinence occurs when the bladder can't empty completely. Once pressure within the bladder becomes high enough that urine dribbles through the urethra. It can be associated with diabetes, spinal cord injury or urethral blockage which may be associated with BPH or prostate cancer. The patient may complain of trouble getting started, a weak urinary stream, and dribbling after urination--or even a constant leakage of small amounts of urine all day long. They often say they feel their bladder is never empty.

 Rick Fields-Gardner