Slide 38 With urge UI and/or an overactive bladder, patients have severe urgency and frequency and usually cannot hold or postpone urination! Detrusor overactivity is a common cause of urge incontinence. This instability causes uninhibited bladder contractions, increasing the urge to void. Uninhibited detrusor contractions due to neurologic conditions are referred to as detrusor hyperreflexia. Detrusor hyperactivity with impaired bladder contractility (DHIC) is more common in the elderly. Overactive bladder is a common term that describes all those conditions listed under urge. Common causes include: Local genitourinary conditions such as cystitis, urethritis, atrophic vaginitis, tumors, stones, diverticula, outflow obstruction, UTI, impaired contractility Central nervous system disorders such as stroke, Parkinsonism, Alzheimer’s disease, brain tumor or aneurysm, and spinal cord injury. Medical conditions such as diabetes mellitus, inadequate fluid intake, habitual frequent voiding. A number of frail, elderly incontinent residents will have involuntary bladder contractions, but not empty their bladder completely. This can cause chronic urinary retention. That is one reason why the MDS requires bladder assessment of all residents with UI. These residents have an absence of normal bladder urge sensations. Many times this is referred to as reflex incontinence.
SLIDE 35 The two most common causes of SUI are: Urethral hypermobility or significant displacement of the urethra and bladder neck during physical exertion when abdominal pressure is increased Intrinsic sphincter deficiency (ISD) is significant failure of the sphincter due to urothelial, myogenic or neurogenic dysfunction of the outlet. ISD may be seen with and without hypermobility of the urethra. Etiology sphincter dysfunction, due to relaxation and weakness of the pelvic floor muscles and reduction in urethral resistance in women, especially those with multiple childbirths, estrogen deficiency, or trauma to the external urinary sphincter in men due to pelvic trauma or sphincter damage during prostatectomy obesity smoking with chronic coughing can contribute to stress UI.
SLIDE 41 - Overflow incontinence occurs when the bladder cannot empty normally and becomes overdistended, leading to frequent, sometimes nearly constant urine loss. Urine loss is usually in small amounts and patients will report dribbling or being unable to “empty my bladder”. Causes include neurologic abnormalities that impair detrusor contractile capacity, including spinal cord lesions, neuropathies (e.g. Diabetes) and any factor that obstructs outflow, e.g., medications, tumors, constipation/fecal impaction, urethral strictures, and prostatic hyperplasia or cancer.
Centers for Medicare and Medicaid Services Urinary Incontinence and Catheters Satellite Broadcast October 27, 2004