Chapter 19 Urinary Incontinence Flashcards
stress incontinence
involuntary loss of urine on effort / physical exertion or on sneezing or coughing.
urgency incontinence
involuntary loss of urine associated with urgency. may be associated with detrusor overactivity.
mixed incontinence
involuntary loss of urine associated with urgency and also with effort or physical exertion or on sneezing or coughing.
overflow incontinence
loss of urine due to poor / absent bladder contractions or bladder outlet obstruction that leads to urinary retention withi overdistension of bladder and overflow incontinence.
risk factor for all types of urinary incontinence
age. OBESITY type 2 diabetes
in postmenopausal women, low estrogen levels may contribute to urinary incontinence. treatment with
local vaginal estrogen shown to improve. whereas oral hrt worsened symptoms.
urinary continence at rest is possible because
intraurethral pressure > (exceeds) intravesical pressure.
continuous internal sphincter contraction is one of the primary mechanisms for maintaining continence
true
goal of diagnostic testing is to distinguish between stress incontinence and urgency incontinence. since treatment for these 2 conditions are
very different.
initial tests include:
stress test, cotton swab test, cystometrogram, and uroflowmetry.
Urinalysis and urine culture should be obtained why?
to rule out infection as a cause of incontinence.
filling the bladder with up to 300ml of normal saline / sterile water through a catheter. pt is asked to cough. clinician observrs to verify the loss of urine.
stress test. if urine leakage witnessed by clinician, pt has stress incontinence.
post void residual (PVR)
obtained with ultrasound of bladder. upper limits of normal post void residual 50-100ml
stress incontinence is
involuntary loss of urine through intact urethra in response to increase in INTRA-ABDOMINAL PRESSURE (coughing, sneezing, or exercise). intravesical pressures > intraurethral pressure.
treatment: lifestyle and behavioral modification including
weight loss, caffeine restriction, fluid management, bladder training, pelvic floor muscle exercises (kegel),
medical therapy for treatment of stress incontinence:
no meds are FDA approved.
incontinence pessaries:
used to physicall elevate and support the urethra, which restores normal anatomic relationships. pts are often given vaginal estrogen to decrease risk of vaginal trauma and ulceration
Urgency Incontinence
involuntary loss of urine associated with urgency and has traditionally been associated with DETRUSOR overactivity usually present with a history of involuntary urine loss and urgency whether or not bladder is full. many women complain of not being able to reach bathroom in time or of dribbling / leaking triggered by just seeing a bathroom. symptoms: urinary urgency, frequency, nocturia.
diagnostic evaluation for urgency incontinence:
diagnosis is clinica; does nto require specialized testing.
treatment of urge incontinence:
- idiopathic urgency (most common type) managed with combination of lifestyle and behavior modifications, medication, and sometimes surgery. Lifestyle and behavioral modifications: weight loss, caffeine restriction, fluid management, bladder training, kegels, PT.
medications used to treat urgency incontinence:
anticholinergic drugs with antimuscarinic effects. act by increasing bladder capacity and decreasing urgency resulting in decreased incidences of incontinence and decreased voids overall. takes up to 4 weeks. premature discontinuation and dose changes should be avoided before this time.
se of anticholinergic drugs:
dry mouth, blurred near vision, tachycardia, drowsiness, decreased cognitive function and constipation.
anticholinergic drugs contraindicated:
in pts with gastric retention and angle closure glaucoma. used with caution in pts with dementia.
overflow incontinence:
due to underactive / acontractile detrusor muscle. as a result, bladder contractions are weak / nonexistent. causing incomplete voiding, urinary retention, and overdistension of bladder.
medications for urgency incontinence:
oxybutynin (ditropan) 5mg po tid to qid
tolterodine (detrol) 2mg po bid
firstline treatment for pt with stress incontinence:
behavioral and lifestyle modifications such as: weight loss, caffeine restriction, fluid management, bladder training, kegels.
UTI is reversible cause of urinary incontinence and should always be ruled out in a patient with urinary incontinence. Urine microscopy is used to evaluate abnormalities of the urine such as hematuria.
t
serum creatinine is a blood test used to assess
kidney function
instruct pt to void on a schedule every
2-3 hrs is one of first interventions to recommend.
___ is an alpha adrenergic agonist used “off label” in treatment of stress incontinence. there is little evidence to support its use for this indication. it does not play a role in treatment of atrophic vaginitis
midodrine
____ and ___ are anticholinergic meds used to treat urgency incontinence.
detrol la and oxybutinin
urgency incontinence:
involuntary urine loss and urgency whether or not the bladder is full. many women c/o not being able to reach the bathroom in time or of dribbling or leaking triggered by just seeing a bathroom.
firstline therapy for urgency incontinence:
lifestyle and behavioral modifications.
