Incontinence

Question 1

What is incontinence?

Answer 1

It is the involuntary loss of urine and is NOT necessarily part of aging.

Question 2

What are some risk factors for incontinence?

Answer 2

women: pregnancy/childbirth, obesity, endocrine issues (diabetes, menopause), pulmonary (cough), neurological (dementia),
men: surgical interventions, neurological (dementia), diabetes

Question 3

describe the neuro pathway for urination:

Answer 3

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.

Question 4

name the different types of incontinence

Answer 4

stress, urge, overflow, transient, mixed, total/continuous

Question 5

what is stress incontinence?

Answer 5

loss of urine when pressure is exerted. (in women, often preceded by children and in men by the prostate being removed)

Question 6

what is urge incontinence?

Answer 6

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.

Question 7

what is overflow incontinence?

Answer 7

iyou constantly dribble urine. may feel like you never truly empty your bladder.

Question 8

what is transient?

Answer 8

it is situational incontience, and may not occur all the time. may be seen with uti.

Question 9

what is mixed incontinence?

Answer 9

it is several of the different types of incontinence.

Question 10

what is total incontinence?

Answer 10

term sometimes used to describe continuous leaking of urine, day and night.

Question 11

What are the functional classifications of incontinence?

Answer 11

failure to empty and failure to store

Question 12

What is failure to empty caused by?

Answer 12

bladder UNDERactivity or uretheral obstruction

Question 13

what is failure to store caused by?

Answer 13

urethral incompetence or bladder overactivity

Question 14

What are the potential causes for transient incontinence?

Answer 14

DIAPPERS
delirium, infection, atrohpic vaginitis, pharmacologic, psychologic, endocrine, restricted mobility, and stool impaction.

Question 15

what is the bladder etiology for incontinence?

Answer 15

detrusor overactivity

Question 16

What is detrusor overactivity? and what are the three types?

Answer 16

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.

Question 17

What is the urethral spinster etiology for incontinence?

Answer 17

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.

Question 18

Is there a grading system for incontinence?

Answer 18

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.

Question 19

A patient who loses urine while laying down would be considered?

Answer 19

grade 3

Question 20

How important is assessing bowel function while assessing incontinence?

Answer 20

very important, could be caused by constipation and fecal incontience

Question 21

What is a good way to get a incontience history for a patient?

Answer 21

voiding log

Question 22

loop diuretics can cause..

Answer 22

polyuria, frequency, and sedation

Question 23

what drugs can cause impaired emptying, retention, delirium, and fecal impaction

Answer 23

anticholinergics, antihistamines, antiarrytmias, antispasmodics, antiparkinsonian, antidiarrheals.

Question 24

What will you want to focus on for the PE?

Answer 24

Neurologic, abdomen, Pelvic exam

Question 25

for PVR, you are measuring urine volume…what are the cutoffs?

Answer 25

400 you need to consider catheritzation.

Question 26

What testing should you order for incontinence?

Answer 26

UA with possible culture, Urodynamics testing: stress testing, PVR< cystourethroscopy, voiding cystometrogram

Question 27

What are the different treatment modalities?

Answer 27

lifestyle changes, behavioral, pharmaceutical, catheters, surgery, barriers

Question 28

What are the lifestyle changes that can be made?

Answer 28

bladder dairy, avoid diuretic drinks, limit fluids

Question 29

What are behavioral changes that can be made?

Answer 29

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)

Question 30

What are some pharmaceutical options?

Answer 30

anticholinergics, beta 3 agonists, tricyclic antidepressants, and estrogen.

Question 31

anticholinergics roles in incontinence:

Answer 31

promote urinary storage by blocking Mu receptor but there dry mouth and constipation SE

Question 32

beta 3 agonists roles in incontinence:

Answer 32

stimulates relaxation promoting storage of urine.

Question 33

tricyclic antidepressants roles in incontinence:

Answer 33

helps to increase urethral resistance. consider for used of mixed incontinence.

Question 34

estrogens roles in incontinence:

Answer 34

good for menopausal atrophic urethral and vaginal changes. helps to stimulate neovascularization, increases alpha receptors.

Question 35

What are the catheter options?

Answer 35

intermittent and indwelling

Question 36

What are some surgery options for OAB incontinence?

Answer 36

surgery for OAB:

1. neuromodulation: stimulation of s3 nerve root
2. denervation
3. botox
4. augmentatin cystoplasty

Question 37

What are some surgery options for stress incontinence?

Answer 37

1. retropubic suspensions 2. mid-urethral sling 3. pelvic organ prolapse repair 4. collagen injections 5. artificial urinary sphincter.