Bladder Disorders Flashcards
Urinary Incontinence RFs in men
- major depression
- incr age
- HTN
- BPH
Urinary Incontinence RFs in women
Parity, vaginal delivery, increased BMI, DM, family hx, hormone replacement, depression, anxiety
Meds that causes Urinary Incontinence
- antiHTN medications
- pain relievers (opioids & COX-2 inhibitors)
- muscle relaxants
- psychiatric medicines
- antihistamines
- anticholinergics
- Alcohol
What antihypertensive meds cause urinary incontinence
- diuretics
- alpha blockers
- ACE inhibitors
- CCB
What psychiatric meds cause urinary incontinence
- antidepressants
- antipsychotics
- sedatives & hypnotics
- antiparkinson agents
Causes of Urinary Incontinence w/o specific urogenital cause
- Delirium
- Infx
- Atrophic urethritis/vaginitis
- Meds
- Psychiatric causes (depression)
- Excessive urinary output (DM, hyperCa++, CHF)
- Restricted mobility
- Stool impaction
Urinary Incontinence Urge pathophys
strong, and often immediate, urge to void followed by an involuntary loss of urine
suggests detrusor overactivity due to irritation in bladder or neurogenic causes
more common in men
Urinary Incontinence Stress pathophys
involuntary loss of urine during physical exertion, effort, coughing, or sneezing, presumably due to elevated intra-abdominal pressure
Much more common in women
Urinary Incontinence Overflow pathophys
loss of urine associated with overdistention of the bladder. Patients complain of frequent or constant leakage or dribbling, or they may lose large amounts of urine without warning
Results from detrusor hypoactivity
Urinary Incontinence Functional pathophys
physical or cognitive impairments that interfere with continence even in patients with normal urinary tracts
Urinary Incontinence S/S
- activity associated w/ leakage?
- loss of small amount of urine during certain activities may suggest stress incontinence
–> physical activity or incr intra-abdo pressure (coughing, sneezing, jumping, lifting, exercise)
–> minimal activity, such as walking or rising from a chair - loss of urine preceded by sudden & severe desire to pass urine may suggest urge incontinence
- In women, ask about pregnancy & childbirth hx
Urinary Incontinence Lifestyle Tx
- Tx reversible causes
- Lifestyle measures: limiting excessive fluid intake, avoiding caffeinated & alcoholic beverages, & attaining a healthy weight
- Scheduled voiding or prompted voiding
- Pelvic floor exercises
Urinary Incontinence Pharmacologic Tx
- Anticholinergic/antimuscarinic meds for urge incontinence (Oxybutynin, Tolterodine)
- Same med can be used for stress incontinence but does not work quite as well
- Desmopressin (synthetic ADH) can be used to nocturia
Vaginal estrogen for vaginal atrophy
Urinary Incontinence s
Surgical Tx
- Surgical decompression of the urethra for obstruction (BPH)
- Bladder/urethral slings
- Artificial sphincters
Overactive Bladder Tx
Anticholinergic/antimuscarinic medications are the drugs of choice for urge incontinence
- Oxybutynin
- Tolterodine
