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  • Dr. Felicia Presenza MD CCFP

How D.I.A.P.E.R.S. can help YOU on your exam

No, we don't mean wearing them...

SNAP SAMP:

You are covering for a long term care facility and a nurse asks you to assess a 86 year old man who is presenting with urinary incontinence.

Questions:

  1. Name 3 types/classifications of urinary incontinence.

  2. Describe 4 transient, short term or modifiable causes of incontinence.

  3. Name 4 conservative management strategies to advise patients who are presenting with urinary incontinence.

  4. Name 2 medications that can be used for patients presenting with urge incontinence/over active bladder.

Answers:

  1. - Urge incontinence - Stress incontinence - Overflow/retention - Mixed, functional - Neurogenic

  2. Use mnemonic DIAPERS: Delirium Infection (UTI) Atrophic vaginitis Pharmaceuticals (anticholinergics, sedatives, hypnotics) Endocrine (diabetes) Retention (BPH)/Reduced mobility Stool impaction (constipation) Others to consider: excessive alcohol or caffeine intake

  3. - Prompted/scheduled voiding - Urge suppression/delayed voiding - Kegel exercises (although evidence for this is very limited) - Pelvic physiotherapy - Weight loss - Limit caffeine intake - Limit alcohol intake - Bowel regimen - Limit fluids after supper

  4. - Anti-muscarinic drugs (oxybutynin, tolterodine, fesoterodine, darifenacin, solifenacin) - Beta-adrenergic agonists (mirabegron) - For women; intravaginal estrogen - TCA (nortriptyline, imipramine)

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