causes of acute incontinence

by Diane K. Newman, RNC, MSN, CRNP, FAAN

Acute (or Transient) Incontinence is caused by a new or recent medical problem that can be treated. Medical conditions such as dehydration, delirium, urinary retention, fecal impaction/constipation, urinary tract infection and atrophic vaginitis can cause an onset of UI. If one of these problems is identified, treatment to correct the problem should be started.

Once the medical problem causing the acute incontinence is resolved, the incontinence should improve. In addition to medical problems, certain medications can cause or contribute to an incontinence problem.

An easy acronym used to remember these causes is the word DRIP. The breakdown of this word is as follows:

D = Delirium, Dehydration, Diapers.
R = Retention, Restricted Mobility.
I = Impaction, Infection, Inflammation.
P = Pharmaceuticals, Polyuria, Paget's Disease.

Table 1

This table explains medical conditions that can cause acute incontinence.

Medical Problems that Cause Incontinence

CAUSE	REASON
Fecal Impaction	Stool (feces) can block the outflow of urine and cause urinary retention. Persons with fecal impaction complain of either urge or overflow incontinence and may have fecal incontinence as well.
Infection	Dysuria, urgency and irritation from a bladder infection may cause or worsen urge incontinence.
Atrophic Vaginitis/Urethritis	A decrease in the estrogen hormone in women causes atrophic (loss of firmness in the tissue) changes in the vagina and around the urethra. The inflammation (swelling) which results from this lack of estrogen can cause urge and stress UI symptoms.
Large amounts of urine production (e.g. uncontrolled diabetes mellitus, hypercalcemia	Large amount of fluid intake or medical conditions that lead to increased output (e.g., hypercalcemia (high calcium levels), hyperglycemia (high sugar levels), and diabetes insipidus), and in persons with congestive heart failure, leg edema (swelling), vein insufficiency, can lead to incontinence by rapid and excessive filling of the bladder. Increased sugar levels in the bladder can cause irritation of the bladder muscle and can lead to UI.
Urinary Retention (incomplete bladder emptying)	Urine leakage can occur because of large amounts still in the bladder after voiding.
Restricted Mobility (decreased ability to walk around)	Decreased or limited mobility can cause incontinence and can frequently be corrected or improved by treating the underlying problem (e.g., arthritis, poor eyesight, Parkinson's disease, or orthostatic hypotension).

Medications that Can Cause UI

MEDICATION	EFFECT ON LOWER URINARY TRACT
Diuretics (water pills)	Diuresis induced by diuretics may precipitate incontinence. This is particularly relevant in older persons and/or in those with already impaired continence.
Sedatives (sleeping pills), Hypnotics CNS Depressants	Benzodiazepines, especially long-acting agents such as flurazepam and diazepam (Valium), may build up in the bloodstream of an older person and cause confusion and alter the persons ability to recognize the urge to void and lead to UI.
Alcohol	Alcohol can alter memory, impair mobility, and cause increased urine output, resulting in incontinence. In addition, it has a sedative effect that may alter a person's awareness of the need to void.
Anticholinergic agents: Antihistamines, Antidepressants (TCA), Phenothiazines, Disopyramides, Opiates, Antispasmodics, Parkinson drugs, Alpha-adrenergic agents	Prescription as well as over-the-counter drugs with anticholinergic properties are taken commonly by persons with insomnia, pruritus (itchy skin), vertigo (dizziness), and other symptoms or conditions. Side effects include urinary retention with associated urinary frequency and overflow incontinence. Besides anticholinergic actions, antipsychotics such as thioridaxine and haloperidol (Haldol) may cause sedation, rigidity (stiffness), and immobility.
Alpha-adrenergic agents (high blood pressure drugs) Sympathomimetics (decongestants), Sympatholytics (e.g., prazosin, terazosin, and doxazosin)	Alpha-adrenergic stimulation increases urethral tone and alpha-adrenergic block reduces it. Alpha-agonists may cause urinary retention symptoms in older men. Stress incontinence may become symptomatic in women treated with alpha-antagonists as antihypertensive therapy. Older men with a large prostate may develop acute urinary retention and overflow incontinence when taking multicomponent "cold" capsules that contain alpha-agonists and anticholinergic agents, especially if a nasal decongestant and a nonprescription hypnotic antihistamine are added.
Calcium channel blockers (heart & blood pressure medications)	Calcium channel blockers can reduce smooth muscle contractility in the bladder and occasionally can cause urinary retention and overflow incontinence.

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Deember 2003