Incontinence Flashcards
which form of incontinence is unique to women?
stress incontinence –have to have a cardinal ligament
what causes stress incontinence
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
what are the most common presentations
sneezing/coughing causing urinary leaking. There is no urgency and no nocturnal.
physical exam shows cystocele. positive q-tip test.
what is normal and not needed in diagnosing stress incontinence
urinalysis and cystometry
what are the treatments?
based on strengthening pelvic floor. Kegel exercises (usually don’t work). Pessary is the most effective treatment. suspension or sling.
what is Overactive bladder
hypertonic bladder. Random spasms of the detrusor muscle.
what does OAB look like?
urgency, nocturia, leak and contraction. always looking for bathroom, but can only go a little bit
what is the treatment for OAB
anti-spasmotics such as oxybutynin.
How do we diagnose OAB
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.
what is hypotonic bladder (overflow bladder/neurogenic bladder)
absent detrusor contractions. Neuro severing. disconnect between the brain and the detrusor. either no urge to void or disconnect between brain and sphincter/detrusor
what is the cause of neurogenic bladder (3)
multiple sclerosis, trauma, overdose of antispasmotics
what happens if someone with neurogenic bladder doesnt go to the bathroom?
The bladder leaks before the bladder explodes. The wall tension will exceed the sphincter tension and urine will leak.
how does neurogenic bladder present
nocturia, regular leakage throughout the day.
LACK OF URGENCY!
There will be bladder distention.
what common patients have neurogenic bladder
para/quadapelegics and MS
how do diagnose neurogenic bladder
urinanalysis not useful. cystometry –no contractions throughout. You can get this from the history.
how to treat neurogenic bladder
Mediccally induce spasms: bethanecol
intermittent and indwelling catheters.
what causes Irritative bladder
stones, cancer, UTI.
INFLAMMATION IS THE OVERARCHING CAUSE.
how does irritative bladder present
urgency, frequency, dyruria
There is not nocturnal incontinence, but the symptoms do wake them at night
how to make the diagnosis of irritative bladder
urinanalysis.
how to treat irritative bladder
If infection: ABs (amoxicillin, nitrofurantoin, trimethoprim/sulfide)
Stones: identified (imaging), capture.
cancer: imaging, surgery.
What is fistula and how does it contribute bladder dysfunction
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
what are the most likely causes of fistula
radiation or inflammation (crohn’s disease).
how to diagnose fistula
physical exam. assessment called tampon test, putting tampon in the fistula and putting blue dye to watch where it goes.
treatment for fistula
surgery typically to remove/repair the fistula
