INCONTINENCE, URINARY

Incontinence may be due to loss of voluntary control of urination, in which case neurologic disorders are usually the cause, or it may result from overflow of a distended bladder (overflow incontinence), in which case the cause may be bladder neck obstruction or a flaccid neurogenic bladder.

1. Loss of voluntary control. The neurologic causes include multiple sclerosis, neurosyphilis, syringomyelia, encephalitis, cerebral arteriosclerosis, frontal lobe tumors and abscesses, senile dementia, and transverse myelitis from trauma or infection. The local causes are a cystocele (often following a hysterectomy) and a damaged urethral sphincter from prostatectomy.
2. Bladder neck obstruction. Benign prostatic hypertrophy, chronic prostatitis, prostate carcinoma, median bar hypertrophy, vesical calculus, and urethral stricture are important mechanical causes of obstruction.
3. Flaccid neurogenic bladder. Drugs such as atropine, tranquilizers, and anesthetics and diseases of the cauda equina and nervi erigentes such as diabetic neuropathy, poliomyelitis, tabes dorsalis, and cauda equina tumors will cause a flaccid neurogenic bladder with overflow incontinence.

INCONTINENCE, URINARY

Approach to the Diagnosis

First, exclude stress incontinence with a pad test. Perineal pads are weighed before and after walking and stress for 30 minutes. An increase in weight identifies urine loss. Catheterization and examination, smear, and culture of the urine are essential at the outset. Cystoscopy and cystometric studies are often needed. Surgical repair of a cystocele or a parasympathomimetic drug in cases of a flaccid neurogenic bladder and propantheline bromide (ProBanthine), a parasympatholytic drug, for spastic neurogenic bladders may be all that is necessary. A neurologist and urologist often need to cooperate in the diagnosis and treatment of these unfortunate individuals.

Other Useful Tests

1. Q-tip test (stress incontinence)
2. Sonogram (test for residual urine)
3. Catheterization for residual urine (bladder neck obstruction)
4. CT scan of the lumbar spine (cauda equina tumor)
5. NCV and EMG (neuropathy)
6. MRI of the brain and spinal cord (multiple sclerosis, etc.)

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Urinary urgency

Read excerpts from these other book chapters related to Urinary urgency:

Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

More About Causes of Urinary urgency

• Back to symptom: Urinary urgency: Introduction (review 39 causes)
• Next Book Extract About Urinary urgency: POLYURIA (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Urinary urgency

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

 » Next page: POLYURIA (Differential Diagnosis in Primary Care)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• POLYURIA (Differential Diagnosis in Primary Care)
• FREQUENCY AND URGENCY OF URINATION (Differential Diagnosis in Primary Care)
• Polyuria (Handbook of Signs & Symptoms (Third Edition))
• Urinary frequency (Handbook of Signs & Symptoms (Third Edition))
• Urinary incontinence (Handbook of Signs & Symptoms (Third Edition))

Tools & Services:

• Bookmark this page
• Take a survey relating to Urinary urgency
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City