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Clin Med- P > incontinence > Flashcards

incontinence Flashcards

1
Q

4 types of incontinence. which is the most common?

A
  1. urge/OAB
  2. stress
  3. overflow
  4. mixed (most common)
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2
Q

the detrusor muscle of the bladder wall responds to ____ by contracting

A

Ach

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3
Q

the inner sphincter of the bladder tightens due to what?

A

activation of alpha adrenergic receptors

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4
Q

what provides extra support of the bladder?

A

pelvic floor muscles

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5
Q

where is the mictrution center of the brain? what does it do?

A

pons: coordinates PSNS stimulation and SNS inhibition

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6
Q

if you lose the pontine inhibition (inhibition of the pons) what happens?

A

neurogenic bladder = incontinence

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7
Q

what drugs can cause urine retention ?

A

sympathomimetics or anti-cholinergics

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8
Q

bladder is a ___ pressure system

A

low

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9
Q

what is vesicoureteral reflux? what can it cause?

A

urine backflow into ureter = renal damage

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10
Q

for mixed incontinence, consider forces involved in ___ and how they are affected by things like _____

A 
micturition 
menopause (decrease estrogen = decrease muscle tone)
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11
Q

increase in bladder wall tone/contractility is not a problem until what?

A

supportive structures are weakened

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12
Q

stress incontinence, common more in women or men?

A

women

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13
Q

what is stress incontinence? what does it come from?

A

comes from an inc. in intrabd pressure and weakened urethral sphincter/pelvic floor muscles (from childbirth or lack of hormones)
-leak a small amount during activities (cough, laugh, sneeze, exercise)

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14
Q

OAB is equal in women and men, but women are ___ times more likely to have _____

A

3x

incontinence

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15
Q

what is a hallmark of OAB?

A

urgency: sensation that is difficult to defer (can’t wait to pee)

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16
Q

what causes OAB?

A

bladder doesnt relax and fill well (from a higher detrussor tone), so it takes less urine to sense stretch and signal the need to pee

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17
Q

urge incontinence is defined as what?

A

when OAB leads to incontinence

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18
Q

urge incontinence is common in what population? why?

A

older/postmenopausal women

  • shorter urethra = less muscle holding tension
  • estrogen withdrawal
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19
Q

how much urine comes out with urge incontinence?

A

moderate to large amounts

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20
Q

what does “LUTS” stand for?

A

lower urinary tract symptoms

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21
Q

overflow incontinence is ______ ______ and results from ______ _______

A

less common, urinary retention

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22
Q

what are the symptoms of overflow incontinence?

A

dribble small amounts frequently

  • trouble starting stream, weak
  • feel bladder isnt empty
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23
Q

what causes overflow incontinence? (2)

A
  1. blockage or narrowed by prolapse

2. muscle/nerve problem (DM, drugs- anti-depressants, smooth muscle relaxers)

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24
Q

what type of incontinence?strong sudden urges to pee?

A

OAB

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25
Q

what type of incontinence? hard to completely urinate

A

urge

26
Q

what type of incontinence?get up 2+ times at night

A

retention/ outlet problem

27
Q

what type of incontinence? urinate >8x in 24hrs

A

OAB

28
Q

what types of food may cause frequency and urgency?

A

caffeine, alcohol, milk, citrus, spices

29
Q

nighttime incontinence without daytime symptoms, consider…

A

LE edema and fluid shifts

- edema in legs during the days goes to the kidneys at night

30
Q

sleep apnea can be associated with what?

A

incontinence (don’t know why)

31
Q

neurogenic bladder: Spastic bladder dysfunction results from …

A

neurologic lesions above the level of the sacral cord

32
Q

neurogenic bladder: Flaccidity of the detrusor muscle is caused by …

A

Flaccidity of the detrusor muscle is caused by disruption of the lower motor neurons of the pelvic nerve

33
Q

what can cause an involuntary contraction of the bladder?

A

when a specific level of stretch is reached

34
Q

5 parts of Dx of incontinence

A
  1. history
  2. pelvic exam
  3. neurologic if appropriate
  4. UA
  5. cystometry
35
Q

pelvic exam for incontinence dx

A
  • check pelvic floor, urethra angle (kinked b/c of prolapse may cause obstructive symptoms).
  • check for atrophic vag (post-menopausal women: stress incontinence)
36
Q

what is cystometry?

A

measures relationship of pressure and volume in bladder, residual volumes, compliance, flow rates and capacity

37
Q

4 kinds of txt for intcontinence

A
  1. behavioral
  2. exercises/devices
  3. medical
  4. surgery
38
Q

behavioral txt for all types of incontinence.

A

Diet modification, bedtime fluid restriction

39
Q

behavioral txt for urge incontinence

A

timed voiding with increasing intervoiding times results in increased bladder capacity

40
Q

4 kinds of exercises/devices for incontinence txt

A

Kegel exercises
Vaginal cones
Pessaries
InterStim device stimulates pudendal nerve, has 80% efficacy

41
Q

what does a vaginal cone do?

A

improves strength and tone

42
Q

what are pessaries for?

A

pushes on neck of bladder. provides support that is no longer there
- for pelvic floor collapse

43
Q

what is the main txt type for OAB and urge? how does it work? what are the preferred agents?

A

medical - anticholinergics to decrease detrussor muscle tone. (trospium/Sanctura for the least ADRs )

44
Q

what drug can be prescribed for stress incontinence? how does it work?

A

SNRI- duloxetine/ Cymbalta : blocks the reuptake of serotonin and NE in the spinal cord

45
Q

what are the concerns with cymbalta?

A

suicide in younger patients taking it

46
Q

surgery is mostly an option for what type of incontinence?

A

stress

47
Q

what are two surgery options for stress incontinence?

A

burch procedure and suburethral slings

48
Q

what is the burch procedure? when is it used?

A

an invasive urethropexy: neck of the bladder is suspended from nearby ligaments with sutures.
-when the bladder or urethra has fallen out of its normal position

49
Q

what is the most popular suburethral sling?

A

“tension free vaginal tape”

50
Q

if its a mechanical problem, its likely a _____ fix

A

mechanical

51
Q

tension free urethral sling (vaginal tape) will not help if ______ _____

A

prolapsed uterus

52
Q

what is intradetrusor botox injection used for?

A

OAB if neurogenic bladder from spinal cord injury or MS

53
Q

what is neuromodulation for OAB?

A

stimulation of S3 afferents with implanted electrodes- thought to reprogram central voiding reflex

54
Q

what are the two types of enuresis (bedwetting) ?

A

primary and secondary

55
Q

below age ___, enuresis is not really a uncommon or a concern

A

7

56
Q

what is primary vs secondary enuresis

A

primary: haven’t ever learned to not wet the bed
secondary: they were trained but have since regressed

57
Q

enuresis: make sure they aren’t drinking within ___ hrs of going to bed

A

3

58
Q

enuresis: Alertness should be maintained for symptoms of common underlying problems such what three things?

A

constipation, stress, cystitis/UTI

59
Q

PE for enuresis

A
  1. abd and pelvic exams
  2. neuro exam of lower extremities
  3. assessment of the “anal wink”
  4. inspect and palpate lumbosacral spine
60
Q

Dx of enuresis

A

UA for UTI, otherwise behavioral assessment, then imaging down the line

61
Q

Txt of enuresis (3 parts)

A
  1. motivational therapy (sticker chart)
  2. enurersis alarms (detect wetness and wake the pt)
  3. desmopressin (ADH hormone) - we should naturally produce more of this at night
62
Q

conditions that may cause or mimic OAB( weeds)

A
  • Bladder detrusor muscle may contact inappropriately due to nerve damage/ infection, surgery, tumors, Parkinson’s, MS, stroke
  • UTIs
  • Polyuria
  • Transitional cell carcinoma of the bladder
  • Underlying neurologic abnormalities
  • BPH

Clin Med- P (124 decks)

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