Incontinence, faecal and urinary
Red flags
- Acute urinary retention with overflow - palpable bladder, dribbling; the commonest reversible cause missed on a ward round
- Cauda equina syndrome - urinary retention or incontinence + saddle anaesthesia + bilateral leg symptoms + loss of anal tone -> urgent MRI, same day
- New neurological signs with incontinence - cord compression, stroke, MS, normal pressure hydrocephalus
- Visible haematuria, or non-visible haematuria with irritative symptoms - bladder cancer until excluded
- New faecal incontinence with rectal bleeding, weight loss or altered bowel habit - colorectal malignancy
- Faecal incontinence with overflow diarrhoea in an immobile older person - faecal impaction; do not treat as gastroenteritis
- Fistula - continuous leakage day and night, post-pelvic surgery/radiotherapy/obstetric injury
- Incontinence + fever + loin pain or delirium - upper tract infection or urosepsis
- Sudden onset over days - always a precipitant: drug, infection, retention, impaction, delirium, immobility, glycosuria
- Pressure injury or excoriated perineum - skin failure is already occurring
7 more sections, plus exam facts
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