Table I : Clinical features of common causes of incontinence1-4
Cause of incontinence Features
Detrusor hyperactivity (urge incontinence) Intense, uncontrollable urge to urinate
Usually large volume of urine leaks out
Absence of stress factors
Obstructive features may co-exist
PVR normal but high in DHIC
Most common cause of geriatric incontinence
Detrusor underactivity Dribbling of urine (small amounts)
Urinary urgency, frequency, nocturia
Urinary retention
PVR high
Uncommon
Bladder outlet obstruction Dribbling of urine (small amounts) after voiding
Urinary urgency, frequency, hesitancy
Nocturia
Urinary retention
PVR high
Second common cause in men
Faecal impaction History of constipation
Faecal incontinence
Relieved with disimpaction
Cystocoele, Uterine prolapse Observed on pelvic examination
Pelvic floor musculature laxity Small amounts of urine loss with coughing,
(stress incontinence) sneezing, laughing
Absent on lying down
PVR low
Second common cause in women
Functional incompetence Presence of physical, mental impairment
Unavailability of toilet facilities/assistance
Increased urine production Features of CHF, ankle oedema or associated diseases.
Drug-induced Single/multiple causative medications on review
Table I : Clinical features of common causes of incontinence1-4Cause of incontinence FeaturesDetrusor hyperactivity (urge incontinence) Intense, uncontrollable urge to urinateUsually large volume of urine leaks outAbsence of stress factorsObstructive features may co-existPVR normal but high in DHICMost common cause of geriatric incontinenceDetrusor underactivity Dribbling of urine (small amounts)Urinary urgency, frequency, nocturiaUrinary retentionPVR highUncommonBladder outlet obstruction Dribbling of urine (small amounts) after voidingUrinary urgency, frequency, hesitancyNocturiaUrinary retentionPVR highSecond common cause in menFaecal impaction History of constipationFaecal incontinenceRelieved with disimpactionCystocoele, Uterine prolapse Observed on pelvic examinationPelvic floor musculature laxity Small amounts of urine loss with coughing,(stress incontinence) sneezing, laughingAbsent on lying downPVR lowSecond common cause in womenFunctional incompetence Presence of physical, mental impairmentUnavailability of toilet facilities/assistanceIncreased urine production Features of CHF, ankle oedema or associated diseases.Drug-induced Single/multiple causative medications on review
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