Ann Clin Psychiatry. 2022 Nov;34(4):227-232. doi: 10.12788/acp.0080.

Brendan T Carroll ^1 2, Lindsay Honaker ³, Jonathan Lazzara ⁴, Elizabeth Schindler ⁵, Peter Silverman ⁶, Bojan Slavnic ⁷, Heather Theibert ⁸, Samantha Zwiebel ⁹, Krishna D Vellanki ¹⁰

Author information

¹Ohio University, Athens, Ohio, USA.

²Wright State University, Dayton, Ohio, USA.

³Cleveland Clinic Lerner College of Medicine, Case Western University, Cleveland, Ohio, USA.

⁴Atrium Hospital, Middletown, Ohio, USA.

⁵Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA.

⁶Offutt Air Force Base, Omaha, Nebraska, USA.

⁷Emory University, Atlanta, Georgia, USA.

⁸Ohio University, Heritage College of Osteopathic Medicine, Dublin, Ohio, USA.

⁹University of Pennsylvania, Philadelphia, Pennsylvania, USA.

¹⁰Prisma Health/University of South Carolina School of Medicine Greenville, Greer Psychiatry Residency, Greenville, South Carolina, USA.

Abstract

Background: Incontinence (urinary or fecal) is not included in DSM-5 criteria for catatonia or in most catatonia rating scales. However, there is a historical basis for the inclusion or consideration of incontinence as a catatonic sign.

Methods: We performed a review of the literature and found references to urinary disturbances and fecal incontinence in 19th- and 20th-century literature. We did a computerized literature review using the terms "catatonia," "catatonic," and "incontinence."

Results: We highlight 2 cases in which urinary or fecal incontinence was a presenting or predominant feature of catatonia. Clinical improvement was associated with improvement in incontinence.

Conclusions: These preliminary findings suggest that urinary and fecal incontinence may be an uncommon presentation of catatonia. Furthermore, incontinence may improve at the same time catatonia improves with treatment. The neural circuitry that controls micturition and the sphincter involves neural pathways and multiple neurotransmitters. Catatonia can cause a reemergence of involuntary or reflex maturation, leading to urinary incontinence. This may lead to the need for additional custodial care for patients. Thus, the detection and monitoring of urinary and fecal incontinence may help us better understand the pathophysiology and impairment associated with catatonia.