Incontinence Flashcards
What is incontinence?
It is the involuntary loss of urine and is NOT necessarily part of aging.
What are some risk factors for incontinence?
women: pregnancy/childbirth, obesity, endocrine issues (diabetes, menopause), pulmonary (cough), neurological (dementia),
men: surgical interventions, neurological (dementia), diabetes
describe the neuro pathway for urination:
When the bladder is full, stretch receptors in the wall of the bladder send nerve impulses to the sacral region of the spinal cord. By way of a parasympathetic response, signals return to the bladder and stimulate contraction of the muscles of the bladder, and relaxation of the internal urethral sphincter. This part of the reflex is involuntary. The external urethral sphincter is voluntary, and under pudendal nerve control from the somatic nervous system. Urination is controlled mainly by the pontine micturition center in the pons. This center receives sensory signals from the bladder and communicates with the cortex about the appropriateness of the urinating at the moment. At times when its not convenient to urinate, the center sends back an inhibition signal back.
name the different types of incontinence
stress, urge, overflow, transient, mixed, total/continuous
what is stress incontinence?
loss of urine when pressure is exerted. (in women, often preceded by children and in men by the prostate being removed)
what is urge incontinence?
sudden, intense urge to urinate followed by involuntary loss of urine. often seen with uti’s, bladder irritants, neuro diseases, and is also known as overactive bladder.
what is overflow incontinence?
iyou constantly dribble urine. may feel like you never truly empty your bladder.
what is transient?
it is situational incontience, and may not occur all the time. may be seen with uti.
what is mixed incontinence?
it is several of the different types of incontinence.
what is total incontinence?
term sometimes used to describe continuous leaking of urine, day and night.
What are the functional classifications of incontinence?
failure to empty and failure to store
What is failure to empty caused by?
bladder UNDERactivity or uretheral obstruction
what is failure to store caused by?
urethral incompetence or bladder overactivity
What are the potential causes for transient incontinence?
DIAPPERS
delirium, infection, atrohpic vaginitis, pharmacologic, psychologic, endocrine, restricted mobility, and stool impaction.
what is the bladder etiology for incontinence?
detrusor overactivity
What is detrusor overactivity? and what are the three types?
symptoms include urgency, urge incontinence, and frequency (>8x a day of urination and >2x/night). A urodynamic study shows involuntary detrusor activity. The two types are neurogenic and idiopathic.
What is the urethral spinster etiology for incontinence?
uretheral resistance. unable to withstand forces created by increased intra abdominal pressure. symptoms include involuntary leakage from the urethra at time of increased exertion. a urodynamic study will show leakage of urine during filling of bladder with valsalva.
Is there a grading system for incontinence?
yes.
Grade 1: patient loses urine with sudden severe increases in abdominal pressure.
Grade 2: patient loses urine with physical movement
Grade 3: patient experiences incontinence without significant relationships to physical activity or position.
A patient who loses urine while laying down would be considered?
grade 3
How important is assessing bowel function while assessing incontinence?
very important, could be caused by constipation and fecal incontience
What is a good way to get a incontience history for a patient?
voiding log
loop diuretics can cause..
polyuria, frequency, and sedation
what drugs can cause impaired emptying, retention, delirium, and fecal impaction
anticholinergics, antihistamines, antiarrytmias, antispasmodics, antiparkinsonian, antidiarrheals.
What will you want to focus on for the PE?
Neurologic, abdomen, Pelvic exam
for PVR, you are measuring urine volume…what are the cutoffs?
400 you need to consider catheritzation.
What testing should you order for incontinence?
UA with possible culture, Urodynamics testing: stress testing, PVR< cystourethroscopy, voiding cystometrogram
What are the different treatment modalities?
lifestyle changes, behavioral, pharmaceutical, catheters, surgery, barriers
What are the lifestyle changes that can be made?
bladder dairy, avoid diuretic drinks, limit fluids
What are behavioral changes that can be made?
bladder retraining, to keep bladder volumes low. This includes time voiding, and double voiding. Also avoid bladder irritants (citrus, caffeine, EtOH, alcohol), and do pelvic floor muscle training (kegel)
What are some pharmaceutical options?
anticholinergics, beta 3 agonists, tricyclic antidepressants, and estrogen.
anticholinergics roles in incontinence:
promote urinary storage by blocking Mu receptor but there dry mouth and constipation SE
beta 3 agonists roles in incontinence:
stimulates relaxation promoting storage of urine.
tricyclic antidepressants roles in incontinence:
helps to increase urethral resistance. consider for used of mixed incontinence.
estrogens roles in incontinence:
good for menopausal atrophic urethral and vaginal changes. helps to stimulate neovascularization, increases alpha receptors.
What are the catheter options?
intermittent and indwelling
What are some surgery options for OAB incontinence?
surgery for OAB:
- neuromodulation: stimulation of s3 nerve root
- denervation
- botox
- augmentatin cystoplasty
What are some surgery options for stress incontinence?
- retropubic suspensions 2. mid-urethral sling 3. pelvic organ prolapse repair 4. collagen injections 5. artificial urinary sphincter.
