Incontinence and Overactive Bladder Flashcards
What is incontinence?
Involuntary release of urine
Overactive bladder is sometimes used in place of incontinence, but frequency and urgency does not always lead to the involuntary loss of urine
Type of Incontinence:
Stress Incontinence?
Muscles of the bladder are weakened with force to include cough, sneezing, heavy lifting, or prolapsed pelvic organs.
Types of Incontinence:
Mixed Incontinence (overflow incontinence)?
Mixture of urge and stress incontinence, this may be associated with bladder outlet obstruction or obstruction present during the voiding process
Types of Incontinence:
Urge Incontinence:
Strong sudden urge to urinate and the patient is unable to control urine resulting involuntary release sooner than expected.
Pathophysiology:
The lower urinary tract is innervated by ____ and ___ neuronal complexes
The lower urinary tract is innervated by efferent and afferent neuronal complexes
Pathophysiology:
What components of the urinary tract determine urination?
Central, peripheral and anatomic
Pathophysiology:
Is the urge to void voluntary or involuntary control?
The urge to void is under voluntary control
Pathophysiology:
What nerve maintains external sphincter and pelvic muscle tone?
Pedestal nerve
Pathophysiology:
What nerve stimulates bladder contraction?
Pelvic nerve
Pathophysiology:
What nerve stimulates internal sphincter closure and detrusor relaxation?
Hypogastric nerve
What qualifies as overactive bladder?
Nocturia at a minimum of two times per night
Urinary urgency and frequency of at least eight times in 24 hour period
Is overactive bladder a natural part of aging?
This is not a normal part of aging.
This condition is seen in the elderly population at higher rates.
Patients have a misconception that this is a normal part of aging
What are the goals of therapy?
- Reduction of urinary frequency, urgency, urinary retention
- Decrease episodes of nocturia
- Restore self-esteem and return to normal social functioning that had previously been interrupted by incontinence or overactive bladder symptoms
- Improvement or resolution of symptoms
What is first-line therapy for overactive bladder?
Anticholinergics/antimuscarinics
How do anticholinergics/antimuscarinics work?
These medications cause an increased bladder capacity, decrease the intensity and frequency of bladder contractions and delay the initial urge to void.
Antagonizing the parasympathetic muscarinic receptors in the bladder with relative selectivity for the M3 and M1 subtypes.
*Oxybutynin is both an antimuscarinic and an antispasmodic as well as a local anesthetic.
Name the anticholinergics/Antimuscarinics
Oxybutin (Ditropan) Tolterodine (Detrol) Darifenacin (Enablex) Solifenacin (Vesicare) Fesosterodine (Toviaz)
What are some side effects of anticholinergics/Antimuscarinics?
Dry mouth
vision changes - blurred vision
Cognitive impairment
Urinary retention
What medication class is used for enuresis in children?
Tricyclic antidepressants (TCA’s)
What are the side effects of Tricyclic antidepressants?
These medications have a high-interaction potential when taken with other medications
Do not use MAOI within 14 days of the use of this medication or other TCA; this can cause serotonin syndrome
What TCA is used for overactive bladder?
Imipramine (Tofranil)
How do serotonin-NE reuptake Inhibitors work for overactive bladder?
Serotonin facilitates urine storage, augmenting parasympathetic innervation and inhibiting sympathetic innervation to the bladder, improving bladder control and urinary storage.
What are the side effects of Serotonin-NE Reuptake Inhibitors?
Nausea within the first week
What is an example of a SNRI for overactive bladder?
Duloxetine (Cymbalta)
Venlafaxine (Effexor)
How do Alpha Adrenergic Antagonists work for overactive bladder?
Alpha Adrenergic Antagonists help to resolve symptoms of urinary obstruction, thus improving symptoms.
Used to treat BPH in males
Use of Tamulosin (Flomax) can be used to improve flow rate, and reduce bladder pressure for treatment of OAB.
What are the side effects of Alpha Adrenergic Antagonists?
Dizziness
Weakness
Retrograde ejaculation
What medications can exacerbate symptoms of OAB?
Diuretics Alpha-adrenergic antagonists Alpha-adrenergic agonists Anticholinergics CCB narcotics Anesthesia
What are some factors that worsen the condition of OAB?
Stroke Spinal cord injury Diabetes Sleep Apnea Depression Estrogen Deficiency Prostate enlargement or cancer UTI Urinary Obstruciton
What are some bladder irritants?
Alcohol Caffeine Tomatoes Artificial sweeteners Grapes Carbonated beverages Strawberries Apple Juice Vinegar Weight loss supplements Spicy foods
How else do caffeine and alcohol affect OAB?
Alcohol and caffeine not only act as bladder irritants but also inhibit ADH release, which in turn, will increase the production of urine and contribute to urgency and frequency.
What are some topics to take into consideration when choosing a treatment for OAB?
History and Physical
Medications previously were taken
Diet and nutritional considerations causing exacerbation of symptoms
