The mnemonic “DIAPPERS” can be helpful in remembering the categories of “transient” urinary incontinence.
- Delirium– When delirium is present, it impedes the recognition of both the need to void and the location of the nearest toilet. Incontinence is common among hospitalized patients with delirium; once it clears, incontinence usually resolves.
- Infection– Symptomatic urinary tract infections can cause or contribute to urgency and incontinence. Asymptomatic bacteriuria does not.
- Atrophic urethritis and vaginitis– These conditions can usually be diagnosed by the presence of vaginal muocosal telangiectasia, petechiae, erosions, erythema, or friability. If symptomatic, urethral inflammation may contribute to incontinence in some women.
- Pharmaceuticals– Medications are one of the most common causes of transient incontinence. Medications include diuretics, anticholinergics, psychotropics, opioid analgesics, alpha-blockers (in women), alpha-agonists (in men) and calcium channel blockers
- Psychological factors– Severe depression may impede the ability or motivation to reach a toilet.
- Excess Urinary Output– Excessive urinary output may overwhelm an older persons’ ability to reach a toilet in time. Common causes include diuretics, excess fluid intake; metabolic abnormalities (eg. Hyperglycemia, hypercalcemia, diabetes insipidus); and disorders associated with peripheral edema.
- Restricted mobility– If mobility cannot be improved, access to a urinal or commode may improve continence
- Stool Impaction-This is a common cause of urinary incontinence in hospitalized or immobile patients.
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