Comorbidity

Effect on Continence

Cardiovascular disease

Arteriovascular disease

Detrusor underactivity or areflexia from ischemic myopathy or neuropathy

Heart failure

Nocturnal diuresis

Metabolic disease

Diabetes mellitus

Detrusor underactivity due to neuropathy, DO, osmotic diuresis; altered mental status from hyper- or hypoglycemia; retention and overflow from constipation

Hypercalcemia

Diuresis, altered mental status

Vitamin-B₁₂ deficiency

Impaired bladder sensation and detrusor underactivity from peripheral neuropathy

Neurologic disease

Cerebrovascular disease, stroke

DO from damage to upper motor neurons; impaired sensation to void from interruption of subcortical pathways; impaired function and cognition

Delirium

Impaired function and cognition

Dementia

DO from damage to upper motor neurons; impaired function and cognition

Multiple sclerosis

DO, areflexia, or sphincter dyssynergia (dependent on level of spinal cord involvement)

Normal-pressure hydrocephalus

DO from compression of frontal inhibitory centers; impaired function and cognition

Parkinson’s disease

DO from loss of inhibitory inputs to pontine micturition center; impaired function and cognition; retention and overflow from constipation

Spinal cord injury

DO, areflexia, or sphincter dyssynergia (dependent on level of injury)

Spinal stenosis

DO from damage to detrusor upper motor neurons (cervical stenosis); DO or areflexia (lumbar stenosis)

Psychiatric disease

Affective and anxiety disorders

Decreased motivation

Alcoholism

Functional and cognitive impairment; rapid diuresis and retention in acute intoxication

Psychosis

Functional and cognitive impairment; decreased motivation

Other organ system diseases

Gastrointestinal disease

Retention and overflow UI from constipation; fecal and urinary incontinence commonly coexist

Musculoskeletal disease

Mobility impairment; DO from cervical myelopathy in rheumatoid arthritis and osteoarthritis

Peripheral venous insufficiency

Nocturnal diuresis

Pulmonary disease

Exacerbation of stress UI by chronic cough