Incontinence Flashcards
Give some examples of stress urinary incontinence
cough, laugh, sneeze, physical exertion
Give an example of urge urinary incontinence
strong urge in the suprapubic area that can’t be held back
What typically causes continuous incontinence?
fistulas
5 underlying causes of urinary incontinence
- Intrinsic sphinteric deficiency
- Urethral hypermobility
- Detrusor overactivity
- Low bladder compliance
- Urinary retention
Urinary incontinence: precipitating factors
- Cough
- laugh
- Movement
- EtoH
- Caffeine
- Constipation
- Immobility
What needs to be performed as part of the physical exam for a patient with urinary incontinence?
- Female: pelvic exam
- Male: prostate exam
- Perineal sensation
- Rectal Exam: stool impaction, bulbocavernosal reflex (squeeze glans look for anal wink)
- Edema in LE
What is the cotton swab test?
During pelvic exam, cotton swab is placed in the urethra, if angle changes more than 30 degrees–> suggests hypermobility!
What will need to be looked at on urinalysis for patient with urinary incontinence?
- glucosuria
- infection
What is the inital imaging to do for a patient with urinary incontinence?
voiding cystourethrogram
If you suspect a patient is having continous incontinence due to a fistula, what is the initial test?
Pyridium test (will turn urine orange)
What are some initial non-invasive options for a femal patient with urinary incontinence?
- Behavioral therapy (ex. voiding diary, bladder training, weight loss, avoid constipation, elevate LE with edema)
- Medication
- Continence devices (Ex. pessary)
Pelvic Floor Muscle training (PFMT)
indicated for SUI, UUI, Mixed UI
- maximal isometric contractions of pelvic floor muscles
- 6-8 seconds
What is a good first line treatment medicine for Urinary incontinence?
Alpha-agonists (increases muscle tone or urinary sphincter)
Ex. Pseudoephedrine, ephedrine
Alpha agonists: contraindications
- cardiac disease
- uncontrolled HTN
- narrow angle glaucoma
- hyperthyroidism
- DM
- High risk for seizure
What are the two main contraindications for Duloxetine?
- nausea
2. Higher rate of suicide
What would be an example of a minimally invasive urinary incontinence treatment for females?
bulking agents injected need urethra
Ex. collagen, graphite, silicone
What is the preferred surgical option for female urinary incontinence
Anterior repair (pubocervical fascia imbricated posteriorly to support bladder)
What are some potential adverse reactions to placement of sling?
- may erode into vagina causing dyspareunia
- Dysuria, hematuria, urinary urgency, urinary frequency, Recurrent UTI
Name the 4 options for non-invasive urinary incontinence in female (Stress Urinary incontinence)
- Behavioral
- Pelvic Floor Muscle Training
- Medication
- Continence devices (ex. pessary)
What should a patient with a new artificial urinary sphincter do daily?
pull down on the pump so that it doesn’t become encapsulated to high
How long does the patient need to heal first before using their artificial sphincter?
6 weeks
What must always be done before placing a urinary catheter in a patient with an artificial urinary sphincter?
the sphincter must be deactivated and locked in the open position
When is the most common time for an infection to occur in a patient with an artificial urinary sphincter?
first 2 months
What are the two big complications to be aware of for an artificial urinary sphincter?
infection and erosion
Overactive bladder
urinary urgency + frequency
Non-invasive options for urge incontinence
- Behavioral Therapy
- Estrogen
- Anticholinergic medication
- Beta adrenergic medication
Minimally invasive tx options for urge incontinence
- Neuromodulation
2. Botulinum
Who is topical estrogen contraindicated for?
- venous thrombosis
- PE
- CVA
- MI
- Estrogen breast cancer
- Liver dysfunction
Anticholinergic medication: MOA
decrease detrusor muscle contractions
Anticholinergic medication: contraindications
- uncontrolled narrow angle glaucoma
- myasthenia gravis
- intestinal obstruction
- gastric retention
- urinary retention
Anticholinergic medications: ADE
- xerostomia (dry mouth)
- constipation
- dizziness
- drowsiness
- blurry vision
- headache
Anticholinergic medications for urge incontinence (examples)
- Oxybutynin
- Tolterodine
3 Fesoterodine
Mirabegron (Myrbetriq)
- Beta adrenergic agonist
- Stimulates beta 3 in the bladder
- relaxes detrusor
- MONITOR FOR HIGH BLOOD PRESSURE**
Augmentation enterocystoplasty
-bladder dome opened and part of the intestines is attached to increase the bladder size
Autoaugmentation
Detrusor muscle incised so bladder capacity expands
