(Medicine of Elderly) (GP)

Overview

• Common condition characterised by uncontrollable leakage of urine
• Most common in elderly females
• Aetiology → neurological causes (multiple sclerosis, spinal injury), genitourinary causes (trauma to pelvic floor, sphincter deficiency, bladder outlet obstruction, pelvic floor weakness), reversible causes (diuretics, UTIs)
• Risk Factors (Urge) → advancing age, high BMI, smoking, caffeine
• Risk Factors (Stress) → vaginal childbirth, hysterectomy

Urethral Strictures can cause incontinence.

Making Diagnosis

Clinical Features:

• Stress Incontinence ⇒ leaking small amounts when coughing, laughing or sneezing (activities that increase intra-abdominal pressure)
• Urge Incontinence (Overactive Bladder - OAB) ⇒ overactivity of detrusor muscle. Strong, sudden sense of urgency, followed by involuntary leakage.
  • Mixed Incontinence ⇒ combination of stress and urge
• Overflow Incontinence ⇒ due to bladder outlet obstruction - overdistended bladder (due to urinary retention) causing leakage (eg. due to prostate enlargement).
  • Can also be caused by TCAs (eg. amitriptyline) due to anticholinergic effect (can lead to urinary retention, leading to frequent leaking)
  • Signs of urinary retention = palpable bladder and suprapubic tenderness. Can also cause delirium in elderly. Drug causes of urinary retention include TCAs (amitriptyline) and opioids.

Investigations:

• Bladder Diaries → should be completed for minimum of 3 days to assess frequency and volume of micturition