Mnemonic for Transient Urinary Incontinence
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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