04-30 Urinary Incontinence Flashcards
1. List the symptoms and signs of the various types of incontinence: stress, urge, overflow and mixed 2. List the transient causes of incontinence 3. Recite the important components of the history and physical in a patient with incontinence 4. Discuss the laboratory, radiologic, or urodynamic tests, if any, that should be ordered in a patient with incontinence 5. Discuss the nonsurgical and surgical treatment options for stress and urge incontinence, describe their side effects, and outline
OBJECTIVE: S/Sx of stress incontinence
—Dysfxn of ________?
—Etiology
PRESENTATION - S/SX
—leaking w/ Valsalva: cough/laugh/ sneezing/getting out of chair/ bending over
DYSFXN of urethra
ETIOLOGY: Either:
—A) pelvic floor weakness
—B) abd P poorly transmitted to crimp off prox urethra during stress event
OBJECTIVE: S/Sx of urge incontinence
—Dysfxn of ________?
—Etiology
PRESENTATION - S/SX
—general: sudden urge they can’t fully suppress
being around water
—severe: can’t make it to the bathroom in time OR
new onset bedwetting in the adult OR
no urge at all, just sudden leak
DYSFXN of bladder (pressure overcomes sphincter)
ETIOLOGY
—detrusor overactivity (neuro or non-neuro) OR high intrabladder P (e.g. 2°to BPH) → poor compliance
OBJECTIVE: S/Sx of overflow
—Dysfxn of ________?
PRESENTATION - S/SX — ♂ > ♀ —seen at extremes of bladder fullness dribbling frequency nocturia urgency may be precip. by stress maneuvers
DYSFXN of bladder
ETIOLOGY
—often obstruct ♂: BPH, stricture
♀: rare prolapse; hypertonic pelv floor
—neuro prob (DM, spinal cord injury)
Overactive bladder
a newer term that describes patients with frequency and urgency with or without urge incontinence
OBJECTIVE: Transient (i.e. reversible) causes of incontinence
DIAPPERS MNEMONIC Delerium Infection Atrophic vaginitis Pharmacologic Psychological Excessive urine production Restricted mobility - environmental Stool impaction
OBJECTIVE: PMHx in a pt w/ incontinence?
PMHx QUESTIONS —Freq? Onset? Severity? Pattern? —Pad use? —Meds? —drinking/voiding habits? —Smoking? —Prev tx? —PMH including neuro? Surg hx? —Bother to pt? Social hx? Job (have to stand?)? —Expectations of treatment
OBJECTIVE: P.E. in a pt w/ incontinence?
PRIMARY CARE abdominal scars distended bladder pelvic atrophic prolapse Kegal – "squeeze my finger" provocative stress test leakage seen w/ ↑ abd P at reasonable vol, 150cc rectal tone? impacted? prostate size? neuro coordination reflexes/sensation MMSE
voiding diary
urodynamics
OBJECTIVE: labs, radiologic, or urodynamic tests to order for pt w/ incontinence
LABS
urinalysis
WBCs?
RBCs?
RADIOLOGY
PVR (post-void residual)
prefer u/s (vs. cath)
URODYNAMICS —only if surgical pt— assess bladder storage bladder overactivity – urge compliance - urge
assess bladder outlet
abnormal bladder neck – stress
assess bladder emptying – overflow
obstruction
OBJECTIVE: meds for incontinence
—MoA
—Side effects
[see slides 45-70]
OBJECTIVE: non-pharm, non-surg tx of incontinence
—MoA
—Side effects
[see slides 45-70]
OBJECTIVE: surgical tx of incontinence
—MoA
—Side effects
[see slides 45-70]
