Incontinence

Question 1

True or False: One of the most common reasons for institutionalization is incontinence

Answer 1

True

Question 2

Prevalence of incontinence increases steadily after what age?

Answer 2

65

Question 3

What percentage of women are affected over the age of 60 that are non-institutionalized?

Answer 3

40%

Question 4

Type of incontinence that occurs with physical exertion

Answer 4

Stress incontinence

Question 5

Risk factors for stress incontinence for women (3)

Answer 5

1. Pregnancy
2. Childbirth
3. Menopause

Question 6

Risk factors for stress incontinence for men (2)

Answer 6

1. Lower UT surgery

2. Urethral sphincter injury

Question 7

Other causes of stress incontinence (4)

Answer 7

1. Obesity
2. Aging
3. Alpha-antagonists
4. ACE inhibitors

Question 8

What is the pathophysiologic problem with stress incontinence?

Answer 8

Decreased urethral sphincter closure forces due to loss of muscle tone/relaxation of muscle

Question 9

What is characteristic of the nature of stress incontinence?

Answer 9

Episodic, low volume leakage

Question 10

Incontinence characterized by leakage of urine and feelings of urgency (sensory response of compelling desire to void)

Answer 10

Urge incontinence or OAB (over-active bladder)

Question 11

Risk factors for urge incontinence (3)

Answer 11

1. Aging
2. Neurologic disease (stroke, PD, MS)
3. Bladder outlet obstruction in men (BPH, prostate cancer)

Question 12

Drug induced causes/triggers of OAB (3)

Answer 12

1. Diuretics
2. Alcohol
3. AChEase inhibitors

Question 13

Pathophysiology of urge incontinence (OAB)

Answer 13

Involuntary bladder (detrusor) muscle contraction during urinary storage phase in the absence of infection

Question 14

Characteristic of the nature of urge incontinence

Answer 14

Large volume leakage

Question 15

Involuntary leakage of urine from an overfilled bladder that cannot empty

Answer 15

Overflow incontinence (chronic urinary retention)

Question 16

Causes of overflow incontinence

Answer 16

More common in men:
1. Bladder outlet obstruction
In women
2. Kinking or obstruction of urethra, radical pelvic surgery

Question 17

Other causes of overflow incontinence (5)

Answer 17

1. Neurologic dysfunction
2. Diabetes
3. Alpha adrenergic agonists
4. TCAs
5. Opioid analgesics

Question 18

Two pathophysiologic mechanisms of overflow incontinence

Answer 18

1. Bladder is full but cannot empty due to bladder dysfunction (too much detrusor relaxation)
2. Urethral sphincter hyperfunction (too much constriction)

Question 19

Other types of incontinence

Answer 19

1. Mixed
2. Functional: UI linked primarily to disease but there is no dysfunction of the urinary tract
   - Dementia, immobility, medications

Question 20

Clinical presentation of stress incontinence (3)

Answer 20

1. Leakage with physical activity
2. Low volume
3. No nocturia

Question 21

Clinical presentation of urge incontinence (3)

Answer 21

1. More than eight times a day
2. High volume leakage
3. Nocturia more than once a night
4. Enuresis (involuntary leakage at nighttime)

Question 22

Clinical presentation of overflow incontinence (5)

Answer 22

1. Lower abdominal fullness
2. Hesitancy, straining to void, decreased force of stream
3. Interrupted stream
4. Sense of incomplete bladder emptying
5. **Increased post-void residual volume (PVR)

Question 23

What is a urinalysis and urine culture used for?

Answer 23

Rule out UTI

Question 24

What do urodynamic studies measure?

Answer 24

1. Postvoid residual volume

2. Bladder pressure