Incontinence of Urine

• Search for a cause:

  • D—delirium, drugs (e.g. antihypertensives)

  • I—infection of urinary tract

  • A—atrophic urethritis

  • P—psychological

  • E—endocrine (e.g. hypercalcaemia); environmental: unfamiliar surrounds

  • R—restricted mobility

  • S—stool impaction, sphincter damage or weakness

• Avoid various drugs (e.g. diuretics, psychotropics, alcohol)

• Weight reduction if obese

In women:

• perform urodynamics to assess stress incontinence

• bladder retraining (instruct patient to delay micturition for 10–15 mins on impulse to void) and pelvic floor exercises (mainstay of treatment)

• physiotherapist referral

• consider a trial of anticholinergic drugs if bladder atony instability or voiding dysfunction (e.g. solifenacin 5–10 mg daily, oxybutynin 2.5–5 mg (o) bd or tds or transdermal patch 3.9 mg (top) twice wkly, tolterodine 2 mg (o) bd, darifenacin 7.5–15 mg (o) d)

• consider surgery for stress incontinence due to urethral sphincter weakness (e.g. suprapubic urethral suspension, Burch procedure [gold standard]; Aldridge sling; tension free vaginal tape procedure)

• consider injection of collagen into paraurethral region

Consider incontinence aids:

• absorbent pads and special pants

• condoms and catheters; urinary drainage bags

• absorbent sheeting