Approach to Urinary Incontinence Flashcards
what is transient UI?
arises suddenly, lasts <6 months and can be reversed
What is stress UI?
leakage of urine with coughing, sneezing, physical exertion
(seen in women)
What is urge incontinence?
urine leak with with sudden urge to void
(women and men)
What is mixed UI?
combo of stress and urgency
What is overflow UI?
retention from detrusor underactivity or outflow obstruction
(men due to prostate enlargement)
What is functional UI?
incontinence in the setting of physical or cognitive impairment which limits mobility or ability to process info about bladder fullness
What are some common risk factors for incontinence?
age
obesity
smoking
parity and menopause (women)
BPH (men)
what is the pathophysiology for stress UI?
pelvic floor musculature and endopelvic fascia weakness
what is the pathophysiology for urge incontinence
detrusor m overactivity and neuroendocrine abberation
what is the pathophysiology for overflow incontinence?
blocked urethra
bladder weakness (diabetes, alcohol, nerve impairment)
enlarged prostate
What is the most important thing when discerning UI?
ASKING about it during the history
(it can be embarrassing for people to talk about)
ask about fluid intake, frequency, night sx, urge, strain, hesitancy, etc)
What pharmacologic factor can cause polyuria and DI?
Lithium
(so make sure you check the pt’s drug list if they have urine issues)
What physical exams should be done for UI?
functional assessment
abdominal exam
urogenital exam (pelvic masses, pelvic floor tone, speculum exam, neuro exam, cough stress test)
What are some urological tests that can be ordered?
UA with calorimetric reagent test + micro
Urine Cx if positive sx or dip
Post void residual volume
voiding diaries
pad testing
how can functional UI be managed?
provide alternative receptacles for urine or planning voids
can try male urinal, commode, condom catheter, reminders to void
What is the DIPPERS assessment for things that may cause transient UI?
delerium
infection
pharmaceuticals
psychological morbidity
excessive fluid intake/urine output
restricted mobility
stool impaction
What is the conservative management for stress incontinence?
monitor fluid intake
manage constipation
eletrical stimulation
mechanical devices
pelvic floor strengthening
smoking cessation
weight loss
what is the management for urge incontinence?
antimuscarinics
intravaginal estrogen
mirabegron
what is the treatment for overflow incontinence?
alpha adrenergic antagonists
what are some behavioural interventions for UI?
monitor fluids
weight loss
smoking cessation
moderate physical activity
PFMT (pelvic floor exercises/kegals)
how does anticholinergics help with UI?
acts directly on detrusor muscle to decrease overactive bladder
what are some invasive treatments for UI?
neuromodulation for Urge UI (direct electrical stimulation to modify bladder sensation)
Intravesical BOTOX for urge UI to act at the detrusor presynaptic NMJ (just as effective as oral meds, repeated q9-12 months)
UI can complicate which aspects of life?
decrease QOL
interfere with social life, sexual function, relationships
negative impact on psyche and increase depression
