Geriatrics (Urinary Incontinence) Flashcards
Urinary Incontinence
-involuntary leakage of urine
-OAB
-stress
-overflow
-more common in females
QOL issues w UI
-loss of independence
-self esteem
-other med complications
Normal bladder function
- Stretch receptors tell brain to empty bladder (B3)
- Neurologic stimulation = contraction (Ach receptors on top and alpha receptors in base)
- Sphincter relaxes
Aging of bladder
-dec capacity and elasticity
-inc spontaneous contractions
-dec sphincter compliance
Age results on bladder
-incomplete emptying
-dec ability to hold it
Types of UI
-urge
-stress
-overflow
-neurlogic
Urge UI (OAB)
-OAB
-hyperactivity of DETRUSSOR muscle
-sudden peeing
-urgency and freq inc
-causes can be neurologic or meds (Ach inhibitors for alzheimers)
Stress UI
-outlet incompetence w ab pressure
-women > men
-small accidents
-childbirth and estrogen deficiency inc risk
-a-ANTAgonists can make worse
-alcohol and caffeine can make worse
Overflow incontinence
-outlet obstruction or inability to or uncordinated DETRUSOR constriction
-common in BPH or prostatic blockage
-ab pain
-freq peeing
-feeling need to go after going
Neurogenic (atonic) bladder
-disruption in neurologic innervation of bladder
-inability or uncoordinated detrusor constriction
-maybe atony of bladder muscle (stroke, neuropathy, spinal cord injury)
Neurogenic Bladder sx
-small accidents
-small volume
-loss of feeling bladder full
-urine dribbling
-freq, urgency
-inc risk of UTI and kidney stones
Functional incontinence
-inability to use bathroom in timely fashion
-physical impairment, mental illness, UTI, meds (sedating)
Meds that inc frequency of urination
-diuretics
-alpha-ANTAgonists
Meds that inc urgency of urinattion
-Ach inhibitors
Meds that inc overflow
-a-antagonists
-antihistamines
UI treamtent
-NON-PHARM works for all!
-pharm
-injections/surgery
Non-pharm UI tx
-scheduled voiding
-kegel
-avoid coffee, alc, caffeine, water before bed
-absorbent products (diapers)
-catheters
-can reduce sx 50%
Pharma options UI tx
-anticholinergics/antimuscarinic (urge)
-B3-agonists (urge)
-topical estrogen (stress)
-a-agonist (stess)
-a-antagonists (overflow)
-SNRI (stress)
Urge UI tx
-give meds 4 weeks to work
-50% vs 30% reduction active vs placebo (response varies)
-65% experience AE
-stopping abrutly might cause worse accidents
Urge UI tx admin
-do not crush or chew
-patch applied twice weekly rotating sites
example case
-Rx can dec episodes from 5 to 2
-nonpharm can dec episodes 5 to 3
-side effects
-costs
Stress UI tx
- Kegel
- Duloxetine 40mg BID
- Topical Estrogen
- A-AGonists (rare)
-vag pessaries/surgery
Duloxetine
-stress UI tx
-40mg BID
-inc sphincter tone to prevent leaks
Topical estrogen (vaginal atrophy)
-stress UI tx
-estrogen vaginal cream
-insert via applicator
-21 days on/ 7 days off
Overflow UI tx
- Address the obstruction
- A-blockers (if BPH)
- Catheter
A-Adrenergic Blockers
-Overflow UI tx in BPH
-Doxazosin 1-4mg qd
-Tamsulosin 0.4mg qd (more selective less hypotension)
Neurogenic UI tx
-no pharma management effective
-focus on non-pharma
-intermittent catheterization
-Botulinum A toxin injections
-Surgery
Intermittent catheterization
-thin tubes collecting urine
-rubber latex, silicone, PVC
Catheter types
-intermittent straight
-Indwelling (Foley)
-Condom
-Suprapubic
UI tx monitoring
-efficacy after 4-8 weeks
-SE mostly dose-dependent
-consider stoping rx as often as they are prescribed
B3 agonist side effects
-minor inc in BP
-UTI
anticholinergic/antimuscarinic side effects
-dry mouth
-constipation
-fatigue/confusion
