Fast Five Quiz: Embarrassing Medical Conditions

George D. Harris, MD, MS

Disclosures

June 27, 2019

Metastatic carcinoma can cause epidural spinal cord compression. Back pain is the initial symptom in most cases. If the sacral cord is involved, urinary incontinence or retention can be expected. Urinary incontinence is an unfavorable prognostic indicator in this patient population. Early diagnosis and treatment of spinal cord compression is extremely important. Paraplegia or quadriplegia can develop within hours or days after the first neurologic deficit appears.

Cortical lesions (eg, from strokes, tumors, aneurysms, or hemorrhages) can lead to inappropriate voiding secondary to decreased social awareness, decreased sensation, or inappropriate urethral sphincter relaxation. Cerebrovascular disease doubles the risk for urinary incontinence in older women.

During episodes of stress incontinence, an increase in intra-abdominal pressure (eg, from laughing, sneezing, coughing, or climbing stairs) raises pressure within the bladder to the point where it exceeds the urethra's resistance to urinary flow. Leakage ceases when bladder pressure again falls below urethral pressure. The major cause of stress incontinence is urethral hypermobility due to impaired support from the pelvic floor. A less common cause is an intrinsic sphincter deficiency, usually secondary to pelvic surgery. In either case, urethral sphincter function is impaired, resulting in urine loss at lower than usual abdominal pressures.

Testing for diabetes mellitus is not routine in the setting of urinary incontinence. However, it should be considered if polyuria and polydipsia are a part of the clinical picture or if diabetes risk factors are present.

Treatment depends on the type of urinary incontinence. The typical approaches are as follows:

  • Stress incontinence : surgery, pelvic floor physiotherapy, anti-incontinence devices, and medication

  • Urge incontinence : changes in diet, behavioral modification, pelvic floor exercises, or medications and new forms of surgical intervention

  • Mixed incontinence : anticholinergic drugs and surgery

  • Overflow incontinence : catheterization regimen or diversion

  • Functional incontinence : treatment of the underlying cause

Read more about urinary incontinence.

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