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There are several forms of incontinence within the palliative setting. A urologic consultation is often advisable.

Total incontinence

Total incontinence is related to complete sphincteric incompetence. Three main pathologies may be responsible:

tumour invasion,

previous surgical procedure,

neurological damage of spinal or nerve root

Endoscopic examination or urodynamic evaluation are rarely necessary in a palliative setting.

Treatment usually involves the use of an indwelling Foley catheter in female patients and condom drainage or penile clamp in male patients (and, if required, also a Foley catheter).

The complicated surgical interventions and rehabilitation required for artificial sphincters are most inappropriate in palliative settings.

Overflow incontinence

Strictly speaking, this is not incontinence but an acute urine retention . The bladder is full as demonstrated by percussion or palpation (see following page).

Urgency incontinence

The bladder musculature in this type of incontinence is normal: the detrusor muscle is too active for a too weak urethral sphincter tonicity. The urge to urinate is so pressing that the patient cannot control it and urinary loss may be abundant. Bedridden patients are often incapacitated to such an extent that they cannot reach the toilet in time.

In palliative cancer setting, the main causes are:

a tumour close to the trigone (bladder, prostate, cervix),

inflammatory reaction of the bladder wall related to irradiation, post-chemotherapy bladder irritation or infection.

Such incontinence may be treated by anticholinergic drugs such as oxybutynin to reduce detrusor activity.

Stress incontinence

This type of incontinence is rarely of concern in a palliative setting. It involves minor involuntary urethral loss when coughing, sneezing, jumping, laughing, standing or walking.

In patients with good prognosis, treatment may involve sphincter surgery. In palliative care, parasympathetolytic drugs such as flavoxate, trospium or tolterodine or possibly low doses of tricyclic antidepressants (imipramine) can be used.