Chapter 19 Urinary Incontinence

Question 1

stress incontinence

Answer 1

involuntary loss of urine on effort / physical exertion or on sneezing or coughing.

Question 2

urgency incontinence

Answer 2

involuntary loss of urine associated with urgency. may be associated with detrusor overactivity.

Question 3

mixed incontinence

Answer 3

involuntary loss of urine associated with urgency and also with effort or physical exertion or on sneezing or coughing.

Question 4

overflow incontinence

Answer 4

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.

Question 5

risk factor for all types of urinary incontinence

Answer 5

age. OBESITY type 2 diabetes

Question 6

in postmenopausal women, low estrogen levels may contribute to urinary incontinence. treatment with

Answer 6

local vaginal estrogen shown to improve. whereas oral hrt worsened symptoms.

Question 7

urinary continence at rest is possible because

Answer 7

intraurethral pressure > (exceeds) intravesical pressure.

Question 8

continuous internal sphincter contraction is one of the primary mechanisms for maintaining continence

Answer 8

true

Question 9

goal of diagnostic testing is to distinguish between stress incontinence and urgency incontinence. since treatment for these 2 conditions are

Answer 9

very different.

Question 10

initial tests include:

Answer 10

stress test, cotton swab test, cystometrogram, and uroflowmetry.

Question 11

Urinalysis and urine culture should be obtained why?

Answer 11

to rule out infection as a cause of incontinence.

Question 12

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.

Answer 12

stress test. if urine leakage witnessed by clinician, pt has stress incontinence.

Question 13

post void residual (PVR)

Answer 13

obtained with ultrasound of bladder. upper limits of normal post void residual 50-100ml

Question 14

stress incontinence is

Answer 14

involuntary loss of urine through intact urethra in response to increase in INTRA-ABDOMINAL PRESSURE (coughing, sneezing, or exercise). intravesical pressures > intraurethral pressure.

Question 15

treatment: lifestyle and behavioral modification including

Answer 15

weight loss, caffeine restriction, fluid management, bladder training, pelvic floor muscle exercises (kegel),

Question 16

medical therapy for treatment of stress incontinence:

Answer 16

no meds are FDA approved.

Question 17

incontinence pessaries:

Answer 17

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

Question 18

Urgency Incontinence

Answer 18

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.

Question 19

diagnostic evaluation for urgency incontinence:

Answer 19

diagnosis is clinica; does nto require specialized testing.

Question 20

treatment of urge incontinence:

Answer 20

1. 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.

Question 21

medications used to treat urgency incontinence:

Answer 21

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.

Question 22

se of anticholinergic drugs:

Answer 22

dry mouth, blurred near vision, tachycardia, drowsiness, decreased cognitive function and constipation.

Question 23

anticholinergic drugs contraindicated:

Answer 23

in pts with gastric retention and angle closure glaucoma. used with caution in pts with dementia.

Question 24

overflow incontinence:

Answer 24

due to underactive / acontractile detrusor muscle. as a result, bladder contractions are weak / nonexistent. causing incomplete voiding, urinary retention, and overdistension of bladder.

Question 25

medications for urgency incontinence:

Answer 25

oxybutynin (ditropan) 5mg po tid to qid

tolterodine (detrol) 2mg po bid

Question 26

firstline treatment for pt with stress incontinence:

Answer 26

behavioral and lifestyle modifications such as: weight loss, caffeine restriction, fluid management, bladder training, kegels.

Question 27

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.

Answer 27

t

Question 28

serum creatinine is a blood test used to assess

Answer 28

kidney function

Question 29

instruct pt to void on a schedule every

Answer 29

2-3 hrs is one of first interventions to recommend.

Question 30

___ 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

Answer 30

midodrine

Question 31

____ and ___ are anticholinergic meds used to treat urgency incontinence.

Answer 31

detrol la and oxybutinin

Question 32

urgency incontinence:

Answer 32

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.

Question 33

firstline therapy for urgency incontinence:

Answer 33

lifestyle and behavioral modifications.