Urinary Retention and Incontinence
Retention
General
Presentation: Decreased urine output accompaniend by abdominal/suprpubic pain +/- overflow incontinence
Diagnosis: Bladder ultrasound (> 400 cc), U/A, urine culture
Treatment: Bladder decompression with Foley x 36 hours
Etiology
Outflow obstruction
Prostate
Benign prostatic hyperplasia (BPH): Start alpha-1 adrenergic antagonist, e.g. tamsulosin 0.4 mg qd
Urinary tract
Trauma
Urethral stricture
Constipation
Neurologic
Cauda equina syndrome: Focal neurologic deficits on exam
Spinal cord injury
Iatrogenic: Medications commonly associated with retention include
Anticholinergics: Scopolamine, oxybutynin (bladder antispasmodic), dicyclomine (Bentyl), benztropine
Antihistamines: Diphenhydramine, hydroxyzine
Muscle relaxants: Cyclobenzaprine (Flexeril)
Neurologic/Psychiatric
Tricyclic antidepressants: Amitriptyline, nortriptyline
Antiparkinsonian: Amantadine, levodopa (Sinamet)
Antipsychotics: Haloperidol, chlorpromazine, fluphenazine (Prolixin), prochlorperazine (Compazine)
Hormonal: Estrogen, progesterone, testosterone
Incontinence
General Incontinence Interview
Perform 3 Question Incontinence Questionnaire
Rule out red flags including hematuria, obstructive symptoms, recurrent UTIs
Rule out reversible causes (DIAPPERS)
Delirium
Infection (acute UTI)
Pharmaceuticals, e.g.
Antihistamine/anticholinergic (retention → overflow incontinence)
Antihypertensive: Diuretics, ACE inhibitors, Calcium channel blockers
Pain medications: COX-2 NSAIDs, muscle relaxants, opioids
Psychological disorder, especially depression
Excessive urine output (e.g. hyperglycemia)
Reduced mobility (i.e. functional incontinence)
Stool impaction (constipation → retention → overflow incontinence)
Explore effect of symptoms on patient’s quality of life
Review 3 day voiding diary