7 - Urinary Incontinence Flashcards
Definition of incontinence?
Involuntary loss or leakage of urine
Continence is dependent on:
Complaint reservoir
Efficient sphincter
Components of efficient sphincter?
Involuntary smooth muscle of bladder neck
Voluntary skeletal muscle of external sphincter
Bladder anatomy
Slide 9
Risk factors for incontinence women
Obesity Age Multiparity Mode of delivery (vaginal) Fam hx
Risk factors for incontinence men
Age Prostate disease UTI hx Constipation DM Neurologic disease
Causes of incontinence?
Transient causes
- potentially reversible
Established causes
- lower UT pathophysiology
- age related physiologic changes
Transient causes
Diappers
Slide 12 if you want
Established causes?
Detrusor overactivity - urge incontinence Urethral incontinence - stress incontinence Urethral obstruction Detrusor underactivity - overflow incontinence
Types of incontinence?
Total - continuous Stress Urge Overflow
Causes of total incontinence?
Loss of sphincter efficiency
Presence of fistulas 2/2
- pelvic/vag surgery
- diverticulitis
Tx for total incontinence?
Surgery
Most important step in eval of total incontinence?
Hx
- degree of leakage
- relation to activity, position, bladder fullness
- timing of onset
- progression
- PMH
- PSH
- meds
- OB hx
PE tests for total incontinence
GU - pelvic exam GI - rectal exam Neuro
Stress test
- pt coughs when standing and full bladder
Labs for total incontinence?
UA + culture (UTI)
BUN/creatinine (renal function)
PSA
Special test for total incontinence?
Post-void residual urine volume
Cystogram
- fistuals or bladder neck
Urodynamic studies (not routine)
- cystometery
- uroflow testing
What is stress incontinence?
Instantaneous urine leakage in response to stress maneuver
- “urethral incontinence”
Prevalence of stress incontinence?
2nd MCC in older women
1st MCC in men w prostatectomy
When is stress incontinence worst?
During the day
- unless another abnormality is present (i.e. detrusor overactivity)
Positive incontinence stress test?
Cough while standing -> leakage
Stress incontinence is associated w?
Pelvic floor laxity Poor support of vesicourethral sphincter unit - multiparous women - pelvic surg - prostate surg
Tx for stress incontinence
Kegel Lifestyle - caffeine/fluids - wt loss Pessaries/vag cones Surgery - sling surgery
Success of sling surgery?
96%
Sling surgery?
Slid 25 has pics
- its just what it sounds like
