Automatic loss of urine.

-Leakage of urine upon coughing, sneezing or standing.

-Urgency and inability to delay urination.


Urinary incontinence in elderly people is typical, and medication can help most patients. Many patients fail to explain to their doctors about it.


1. Transient.

Use of the mnemonic “DIAPPERS” may be helpful in remembering the categories of “transient” urinary incontinence.

1. Delirium.

Delirium is the most common cause of incontinence in hospitalized patients; once it clears, incontinence usually resolves.

2. Infection.

Urinary tract infection commonly causes or contributes to urgency and incontinence.

3. Atrophic urethritis and vaginitis.

 Urethritis and vaginitis

4. Medications. 

These are one of the most common causes of transient incontinence. Typical offending agents include potent diuretics, anticholinergics, psychotropics, opioid analgesics, alpha-blockers (in women), alpha-agonists (in men), and calcium channel blockers.

5. Psychological factors.

Severe depression with psychomotor retardation may impede the ability or motivation to reach a toilet.

6. Excess urinary output.

Excess urinary output may overwhelm the ability of an older person to reach a toilet in time.

7. Stool impaction.

This is a common cause of urinary incontinence in hospitalized or immobile patients.


– Detrusor overactivity (urge incontinence)—Detrusor overactivity refers to uninhibited bladder contractions that cause leakage.

– Urethral incompetence (stress incontinence)— Urethral incompetence is the second most common cause of established urinary incontinence in older women.

– Urethral obstruction—Urethral obstruction (due to prostatic enlargement, urethral stricture,bladder neck contracture, or prostatic cancer) is a common cause of established incontinence in older men but is rare in older women.

– Detrusor underactivity (overflow incontinence)—Detrusor underactivity is the least common cause of incontinence. It may be idiopathic or due to sacral lower motor nerve dysfunction.


Men with urinary obstruction who do not respond to medical therapy should be referred to a urologist.

Women who do not respond to medical and behavioral therapy should be referred to a urogynecologist or urologist.

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