Module 2 exam 1 lecture 2 Flashcards
Urinary incontinence is
Involuntary leakage of urine
overactive bladder
what percent of LTC pts have urinary incontinence? What percentage of hospitalized older adults have incontinence?
60% of LTC pts
30% of hospitalized
More common in females than males
types and frequency of UI in females
63%- urge
21%- stress
12% overflow
Types and frequency of UI in males
59%- Urge
29%- overflow
0% stress
How does bladder work?
Bladder has smooth muscle surrounding it that squeezes the top of the bladder and squeezes urine out.
steps in bladder function
stretch receptors notify brain that bladder is full and needs emptying
neurologic stimulation initiates contraction
which receptor supports detrusors relaxation and filling
B3
How does neurologic stimulation initiate contraction
-Ach receptors in the dome (top of bladder)
-Alpha adrenergic receptors in the sphincter found in the base of the proximal urethra relaxes the muscle to allow it to flow out.
What are some age related changes to the bladder and urethra
Decrease bladder capacity/elasticity
increased spontaneous detrusor contractions
decreased sphincter compliance
all of these result in incomplete emptying and decreased ability to postpone urination
overflow results from
results from blockage or inappropriate/inefficient sphincter relaxation
what is stress
occurs in women, change in hormones or pelvic floor
what is urge
Cholinergic receptor squeezes too often or at inappropriate time
urge other name
overactive bladder
urge caused by ? volume?
hyperactivity of detrusor muscle causes sudden and poorly predictable voiding
large or small volume accidents
sx of urges
Urgency- unpredictable or unabble to control
frequency- excessive feelings of urination
causes of urge
Neurologic or medication
stress incontinence occurs when? symptoms? caused by?
Happens when external urinary sphincter does not open to allow urine to leave. small volume leakage, can be exacerbated or caused by alpha-antagonists (also called outlet incontinence)
Can occur when laughing, caffeine or alcohol
What does overflow incontinence result from
results from outlet obstruction or inability for detrusor constriction or uncoordinated detrustor constriction
overflow incontinence is most commonly caused bu
BPH or prostate blockage or kidney stone
sx of overflow incontinence
abdominal discomfort or pain
feeling the need to void shortly after voiding
What is another name for neurogenic bladder
Atonic bladder
What is neurogenic bladder?
disruption in neurogenic innervation of the bladder or inability or uncoordinated detrusor constriction
symptoms of neurogenic bladder. Possible complications
small volume, loss of feeling like bladder is full, dribbling of urine
Iincrease in risk of UTI
increase risk of kidney stones
What is functional incontinence? causes?
Inability to get to the bathroom on time.
caused by medication (sedating)
physical impairment/mental status
UTI
Meds that cause frequency incontinence
diuretics
alpha blockers
MEds that cause urgency
acetylcholinesterase inhibitors
Meds that cause overflow
alpha-antagonists
anti-histamines
non pcol therapy for incontinence
scheduled/timed voiding
kegels for pelvic floor muscle
avoid- caffeine, alcohol, h20 before bed
diapers
catheters
Injection/surgery does not work on
functional
Non pcol is the preferred tx option for which kinds of incontinence
overflow, stress, urge, functional, neurogenic
urge incontinence can be treated by which pcol options
anticholinergic/antimuscarinic
B3 agonist
inj/surgery
functional can be treated by
Non pcol only
neurogenic can be treated by
inj/surgery
non pcol
stress incontinence can be treated by
estrogen (topical)
alpha-agonist (small function)
SNRI (small function)
Inj or surgery
overflow incontinence can be treated by
alpha-agonist (small function)
inj/surgery
TX for urge UI in order
Non-pcol
pcol a)anticholinergic/antimuscarinic
b) B3- agonist
c) combination
Injection/surgery
Anticholinergic drugs and ROA
oxybutyrin - oral, patch, gel
tolterodine- oral
solifenacin
darifenacin
trospium
fesoterodine
adverse effects of anticholinergic drugs
dry mouth
constipation
fatigue, confusion
tachycardia
B-3 agonist drugs
Mirabegron
vibegron
side effects of B-3 drugs
Mirabegron- minor increase in BP, UTI
vibegron- uti
efficacy of B3 agonist in UI
30-60% decrease in UI
Max benefits of anticholinergics and B3 are in how long
2-4 weeks
stress UI management
non-pcol (kegels)
SNRI- duloxetine increases sphincter tone
topical estrogen- women only 21 days on 7 days off
vaginal pessaries or surgery
Overflow UI management
address obstruction
BPH- doxazosin/tamsulosin can relax sphincter (tamsulosin more selective)
catheter
Neurogenic UI management
focus on non pcol mgmt
intermittent catheterization
botox or surgery
drugs not effective for neurogenic
