Overactive Bladder in the Elderly
Clinical Overview

Reversible Incontinence

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Disease Conditions

A variety of medical conditions can cause UI. Conditions affecting cognition are important to consider as contributors to UI due to the patient’s inability to comprehend the need to void or how to act on the urge to void. Physical conditions may limit the patient’s ability to reach the toilet to avoid an incontinent episode. An acute infection may cause UI, and could contribute further to UI because of the potential for an associated delirium in elderly patients with a urinary tract infection.

Other conditions that increase the risk of developing UI include diabetes, heart failure, lower urinary tract abnormalities, neurological conditions, and others listed below. Tables 2 and 3 are acronyms that are useful for recalling and ruling out these problems as potential causes of UI. 

Additional conditions that should be evaluated include:
  • Obstruction (e.g. benign prostatic hyperplasia)
  • Bladder abnormalities (e.g. tumors; interstitial cystitis)
  • Sphincter weakness
  • Neurologic conditions (stroke, Parkinson’s, multiple sclerosis, spinal cord injury, diabetic neuropathy, nerve injury)
  • Heart failure (volume overload)
  • Diabetes mellitus (osmotic diuresis and polyuria)
  • Sleep disorders (sleep apnea, restless legs)
  • Chronic anxiety
  • Impaired mobility (e.g. joint disease, muscle weakness, osteoporosis)
Ouslander JG.  Management of overactive bladder. N Engl J Med. 2004 Feb 19;350(8):786-99.

 

Table 2: DRIP

D

delirium, depression

R

restricted mobility, retention

I

infection, inflammation (in or around urinary tract), impaction

P

polyuria, pharmaceuticals
Ouslander JG, Schnelle JF. Incontinence in the nursing home. Ann Intern Med. 1995 Mar 15;122(6):438-49.

 

Table 3: DIAPERS

D

delirium or confusion

I

infection, impaction

A

atrophic vaginitis or urethritis

P

pharmaceutical agents (see Table 1)

P

psychological factors (depression, dementia)

E

excess urine output

R

restricted mobility

S

stool impaction
Staskin DR. Drugs Aging. 2005;22(12):1013-28.