1. Why is this lady unhappy?

2. Lost at bingo?
Dr. Sloan didn’t show up?
Dr. Sloan DID show up?
Chronic pain?
Depression?

3. …NONE of the above:

4. it’s INCONTINENCE!

6. Bladder Physiology for Dummies
DETRUSOR: cholinergic
SPHINCTER:
alpha-adrenergic contracts
beta-adrenergic relaxes

7. Bladder Anatomy for Dummies
The urethro-vesical angle

9. THE INCONTINENCE ALGORITHM DIAGRAM

11. If you don’t like my mnemonic…

12. Use this acronym "DIAPPERS" to quickly remember factors to be considered when assessing urinary incontinence.
 Delirium/confusional states
 Infection-urinary (symptomatic)
 Atrophic urethritis/vaginitis
 Pharmaceuticals
 Psychological, especially depression
 Excessive excretion (i.e., CHF, hyperglycemia)
 Restricted mobility
 Stool impaction

13. REALLY SIMPLE APPROACH:
Identify Remediables
Fix Remediables
Try Drugs
(4. Hand it Over to the Nurses)

14. THE REMEDIABLES
“PLAID”
Infection
Impaction
Obstruction

15. DRUG THERAPY Anticholinergics Medical un-obstructors Other autonomics
Estrogen

16. FECAL INCONTINENCE

17. Fecal Impaction Excess Laxatives Cognitive (obtundtation)
All Diarrhea Causes
Local Causes