urinary continence

Question 1

urinary incontinence

Answer 1

-NOT a physiological aging change
-can be improved / cured
-To maintain continence -> must have intact cognitive, neurologic, muscular, and urologic systems.
-Consciousness, motivation, comprehension, and attention are needed to properly recognize the need to void.
-Leading risk factors increasing age, female sex, cognitive impairment, genitourinary surgery, obesity, and impaired mobility.
-Prevention: reduce the impact of chronic disease on incontinence-related risk; measures to reduce the impact and frequency of the condition

Question 2

urinary incontinence epidemiology

Answer 2

-Underreported by older adults
-Incontinence is MC in women than in men (2:1) until age 80 -> M=F
-Urge incontinence is the MC type
-Important effect on the quality of life
-Contributes to limitation in activities, embarrassment, and depression

Question 3

appropriate evaluation

Answer 3

-urinalysis at first eval
-Directed hx and PE
-careful review of meds that could worsen incontinence
-Testing – UA, culture, Post-voidal residual (PVR), diaries, referral to urologist, urodynamics

Question 4

transient causes of incontinence: DIAPPERS

Answer 4

-Delirium (acute disease, postoperative)
-Infection/Illness
-Atrophic urethritis or vaginitis
-Pharmaceuticals - anticholinergics, diuretics, EtOH, narcotics, sedatives
-Psychological factors

-Excess urinary output
-Drugs, BPH, Infection/inflammation, hyperglycemia, CHF

-Restricted mobility (DJD, orthostatic hypotension, gait disorders, restraints)
-Stool impaction

Question 5

urgency UI (UUI)

Answer 5

-involuntary loss of urine associated with a sense of urgency.
-Potential causes: Idiopathic or associated with neurologic disorders (eg, stroke, MS, Parkinson disease), bladder irritants, stones, infection or tumors.
-detrusor over activity with impaired contractility -> bladder is contracted

Question 6

stress UI (SUI)

Answer 6

-involuntary loss of urine associated with effort or physical exertion such as coughing or sneezing.
-Potential causes: Failure of the urethral sphincter closure, insufficient pelvic support in women, or prostate surgery in men.
-trauma, atrophic vaginitis…

Question 7

Mixed UI (MUI)

Answer 7

-involuntary loss of urine associated with urgency & also with effort or physical exertion such as coughing or sneezing.
-Potential causes:A combination of causes discussed above for SUI and UUI.

Question 8

history

Answer 8

-Onset and course of incontinence
-Precipitating factors
-Frequency, timing, and volume of urinary incontinence- dont drink before bed
-Fluid, caffeine, and alcohol intake
-Amount and types of pads
-Other lower urinary tract symptoms
-Bowel and sexual function
-Medications
-Most bothersome symptom and patient goals for treatment

-red flags- sudden onset, pain, hematuria, dysuria, straining, inability to void

Question 9

meds that can contribute to UTI

Answer 9

Question 10

physical exam

Answer 10

-Signs of fluid retention
-Neurologic examination
-Pelvic examination - ask them to cough
-Rectal examination
-Prostate examination
-Mobility
-Mental status
-Observation of urine leakage
-Postvoid residual volume
-Urinalysis and culture if indicated
-Kidney function assessment

Question 11

complications

Answer 11

-Physical and psychological effects
-Higher rates of anxiety, depression, and sexual dysfunction/sexual function
-Social withdrawal
-Sleep disruption
-Dermatitis, candidiasis, cellulitis, skin breakdown
-Pressure injuries
-Increase in falls with UI
-Hydronephrosis and renal dysfunction

Question 12

treatment: urge

Answer 12

-Medications- anticholinergics, estrogen, beta 3 agonist
-Bladder retraining
-Fluid management
-Timed voids
-overactive bladder

Question 13

habit training

Answer 13

-Pelvic floor muscle exercises
-Medications

Question 14

stress tx

Answer 14

-Pelvic floor muscle exercises
-Surgery

Question 15

overflow tx

Answer 15

-Relief of obstruction
-Supportive treatment for detrusor underactivity
-alpha blockers

Question 16

overview of tx

Answer 16

-Life-style modifications
-Behavioral therapy
-Pharmacotherapy

-prompted voiding for pts with cognitive impairment

-Antimuscarinic- oxybutynin, tolterodine
-reduces bladder contraction and increases bladder capacity.
-S/E: dry eyes and mouth, constipation, headache, dizziness, orthostatic blood pressure changes, and confusion

-Devices
-Surgical intervention

-Immediate release, sustained release and transdermal patch

-β3-Adrenergic agonists: Mirabegron:
-cause hypertension
-for over active bladder
-relaxes bladder

-Alpha blocker- Tamsulosin Flomax
-BPH
-hypotension
-relax bladder muscles

-Pelvic floor muscle exercises (Kegel exercises)

-catheter for 3-4 weeks if retention, start alpha blocker

Question 17

behavioral tx

Answer 17

-Fluid intake
-Timed voiding
-Bladder retraining
-Habit training
-Prompted voiding