Source: Rovner ES, Wyman J, Lam S. Urinary incontinence. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=133892819. Accessed May 10, 2017.
Urinary incontinence (UI) occurs as a result of overfunctioning or underfunctioning of urethra, bladder, or both.
Stress UI (SUI) results from urethral underactivity and occurs during periods of physical activity (eg, exercise, coughing, and sneezing)
Urge UI (UUI) results from bladder overactivity.
Overflow incontinence results from urethral overactivity and/or bladder underactivity.
Mixed incontinence results from bladder overactivity and urethral underactivity.
Functional incontinence linked to primary disease process such as dementia or cognitive or mobility deficits.
Many medications can aggravate voiding dysfunction and UI (Table 1).
TABLE 1.Medications That Influence Lower Urinary Tract Function |Favorite Table|Download (.pdf) TABLE 1. Medications That Influence Lower Urinary Tract Function
|Medication ||Effect |
|Diuretics, acetylcholinesterase inhibitors ||Polyuria resulting in urinary frequency, urgency |
|α-Receptor antagonists ||Urethral relaxation and SUI |
|α-Receptor agonists ||Urethral muscle constriction (increased urethral closure forces) resulting in urinary retention (more common in men) |
|Calcium channel blockers ||Urinary retention due to reduced bladder contractility |
|Narcotic analgesics ||Urinary retention due to reduced bladder contractility |
|Sedative hypnotics ||Functional incontinence caused by delirium, immobility |
|Antipsychotics ||Anticholinergic effects resulting in reduced bladder contractility and urinary retention |
|Anticholinergics ||Urinary retention due to reduced bladder contractility |
|Antidepressants, tricyclic ||Anticholinergic effects resulting in reduced bladder contractility, and α-antagonist effects resulting in urethral smooth muscle contraction (increased urethral closure forces) both contributing to urinary retention |
|Alcohol ||Polyuria resulting in urinary frequency, urgency |
|ACEIs ||Cough as result of ACEIs may aggravate SUI |
Urethral sphincter maintains adequate resistance to flow of urine from bladder until voluntary voiding initiated.
Normal bladder emptying occurs with opening of urethra concomitant with volitional bladder contraction.
True prevalence difficult to determine.
Peak incidence in women at the time of menopause.
Chronic UI is one of the most common reasons cited for institutionalization of the elderly in the US, and the condition is frequently encountered in the nursing home setting.
Twice as common in women as in men.