Incontinence

Question 1

which form of incontinence is unique to women?

Answer 1

stress incontinence –have to have a cardinal ligament

Question 2

what causes stress incontinence

Answer 2

big and multiple births that stress the cardinal ligament. Loose and floppy cardinal ligament causes a cystocele. The pressure pushes on the bladder, but not on the sphincter –as it usually does to keep it closed and equalizing pressure.

Sphincter has descended in the vagina, but NOT the bladder. Thus the pressure is not equalivalent when intraabdominal pressure increases

Question 3

what are the most common presentations

Answer 3

sneezing/coughing causing urinary leaking. There is no urgency and no nocturnal.
physical exam shows cystocele. positive q-tip test.

Question 4

what is normal and not needed in diagnosing stress incontinence

Answer 4

urinalysis and cystometry

Question 5

what are the treatments?

Answer 5

based on strengthening pelvic floor. Kegel exercises (usually don’t work). Pessary is the most effective treatment. suspension or sling.

Question 6

what is Overactive bladder

Answer 6

hypertonic bladder. Random spasms of the detrusor muscle.

Question 7

what does OAB look like?

Answer 7

urgency, nocturia, leak and contraction. always looking for bathroom, but can only go a little bit

Question 8

what is the treatment for OAB

Answer 8

anti-spasmotics such as oxybutynin.

Question 9

How do we diagnose OAB

Answer 9

cystometry. void to nothing. allow for accumulation of urine, measure detrusor contractions throughout. If there are random spikes of detrusor contractions at all times then this is the diagnosis.

Question 10

what is hypotonic bladder (overflow bladder/neurogenic bladder)

Answer 10

absent detrusor contractions. Neuro severing. disconnect between the brain and the detrusor. either no urge to void or disconnect between brain and sphincter/detrusor

Question 11

what is the cause of neurogenic bladder (3)

Answer 11

multiple sclerosis, trauma, overdose of antispasmotics

Question 12

what happens if someone with neurogenic bladder doesnt go to the bathroom?

Answer 12

The bladder leaks before the bladder explodes. The wall tension will exceed the sphincter tension and urine will leak.

Question 13

how does neurogenic bladder present

Answer 13

nocturia, regular leakage throughout the day.

LACK OF URGENCY!

There will be bladder distention.

Question 14

what common patients have neurogenic bladder

Answer 14

para/quadapelegics and MS

Question 15

how do diagnose neurogenic bladder

Answer 15

urinanalysis not useful. cystometry –no contractions throughout. You can get this from the history.

Question 16

how to treat neurogenic bladder

Answer 16

Mediccally induce spasms: bethanecol

intermittent and indwelling catheters.

Question 17

what causes Irritative bladder

Answer 17

stones, cancer, UTI.

INFLAMMATION IS THE OVERARCHING CAUSE.

Question 18

how does irritative bladder present

Answer 18

urgency, frequency, dyruria

There is not nocturnal incontinence, but the symptoms do wake them at night

Question 19

how to make the diagnosis of irritative bladder

Answer 19

urinanalysis.

Question 20

how to treat irritative bladder

Answer 20

If infection: ABs (amoxicillin, nitrofurantoin, trimethoprim/sulfide)
Stones: identified (imaging), capture.
cancer: imaging, surgery.

Question 21

What is fistula and how does it contribute bladder dysfunction

Answer 21

epithelialized track between two organs. This can cause a continuous leak. there will be normal bladder function, but a constant leak to where ever the fistula goes

Question 22

what are the most likely causes of fistula

Answer 22

radiation or inflammation (crohn’s disease).

Question 23

how to diagnose fistula

Answer 23

physical exam. assessment called tampon test, putting tampon in the fistula and putting blue dye to watch where it goes.

Question 24

treatment for fistula

Answer 24

surgery typically to remove/repair the fistula