Renal & Urology / Incontinence Flashcards
What is urinary incontinence?
Involuntary loss of urine
What are the types of urinary incontinence?
- stress incontinence
- urge incontinence
- neuropathic incontinence (overflow)
- mixed incontinence
What is stress incontinence?
- Involuntary loss of urine when the intraabdominal pressure (created by coughing, lifting, sneezing) is greater than the pressure generated by the urinary sphincter
What patient population is most commonly affected by stress incontinence?
- Middle-aged
- multiparous women
What is the underlying pathophysiology of stress incontinence?
Weakness of the pelvic floor and hypermobility of the vesicourethral segment
What is a Marshall test and when is it positive?
- With a full bladder, a woman lies on her back with her knees bent and feet in stirrups (dorsal lithotomy)
- then the examiner observes the urethral meatus when the patient coughs.
- If urine leaks, the test is positive and indicates pelvic floor instability.
What is the definitive treatment for stress incontinence?
Surgical pelvic floor suspension
What other nonpharmacologic therapy can help stress incontinence?
Mild cases can respond to Kegel exercises to strengthen the pelvic floor musculature or the use of pessaries in females
What is urge incontinence?
Incontinence due to detrusor muscle spasms acting against a functioning urinary sphincter resulting in a sudden urge to urinate
What are the common signs of urge incontinence?
No findings on physical examination, but urodynamic studies will detect abnormality
What medications are used to treat urge incontinence?
- Anticholinergic medications (oxybutynin, tolterodine) to prevent detrusor spasm
What are the common side effects of anticholinergic medications?
- Dry mouth
- dizziness
- drowsiness
- urinary retention
- constipation
- nausea
- blurry vision
What is an absolute contraindication to anticholinergic therapy?
Uncontrolled narrow angle glaucoma
What is neuropathic incontinence?
Incontinence caused by a lesion of the nervous system (stroke, spinal cord lesion, dementia)
What is the treatment for neuropathic incontinence?
Intermittent self-catheterization
