Urinary Frequency Flashcards
How aging effects GU system in specifically women and what are the symptoms resulting
. Atrophy of labia causing dec. lubrication and dyspareunia
. Weakening of pelvic floor muscles causing urinary incontinence
How aging affects GU system in specifically men and what results?
Enlarged prostate causing urinary incontinence/urgency/ or dribbling due to BPH
How aging affects GU system in all genders
. Dec. renal salt retention/regulation, dec. ADH secretion at night, decline in Renal function
. Causes potential orthostatic hypotension, inc. nocturia,and changes in medication metabolism and excretion
Basic activities of daily living
. Eating . Bathing/toileting . Ambulating . Dressing . Maintaining personal hygiene
Instrumental activities of daily living
. Managing finances . Managing transportation . Preparing food . Shopping . Managing meds . Housekeeping
Common causes of transient urinary incontinence
. Delirium (common in hospitalized patients)
. Infection
. Atrophic urethritis/vaginitis (physical exam finding)
. Meds
. Severe depression
. Excessive urine output from diuretics/metabolic abnormalities
. Restricted mobility
. Stool impaction
Urge incontinence
. Detrusor (smooth muscle under ANS) overactivity
. Causes uninhibited bladder contractions
. Most common
. Idiopathic
. Treatment: schedule voiding and other behavioral exercises
Stress incontinence
. Urethral incompetence
. Seen in men after prostatectomy
. Instantaneous leakage of urine in response to stress maneuver (laughing, coughing, lifting)
. Coexists w/ detrusor overactivity
. Women can be caused by pelvic muscle weakness/vaginal atrophy from menopause
. Treatment in women: kegels to strengthen pelvic floor
Urethral obstruction
. Prostatic enlargement, urethal stricture, bladder neck contracture, prostate cancer
. Outflow obstruction
Overflow incontinence
. Detrusor underactivity
. Least common
. Frequent leakage of small amts of urine
. Elevated postvoid residual urine (over 450 cc) when normal postvoid residual is <50 cc
. Mechanical obstruction (BPH)
. Treatment: surgery/meds
Metabolic issues causing urinary frequency
. Diabetic ketoacidosis (poorly controlled diabetes causing osmolar diuresis)
Infections that can cause urinary frequency
. STD
. UTI
. Cystitis
Anatomical reasons that could cause urinary frequency
. Benign prostate hyperplasia (BPH)
. Bladder malignancy/Prostate malignancy
Polyuria
Urine output higher than 3L per day
T/F urinary frequency can exist w/o polyuria
T
Symptoms of frequent urination
. Burning on urination, sometimes w/ hematuria (injection, stones, tumors, UTI)
. Urinary urgency w/ neurologic symptoms like weakness/paralysis from stroke
. Hesitancy to start urinary stream, straining to void, reduced size/force of stream, dribbling during or end of urination (BPH, urethral stricture, obstructive lesion)
Muscles of anal canal
. External and internal anal sphincter
Where does angle of anal canal lie?
Line between anus and umblilicus
What nerve supply goes to anal canal?
Somatic sensory nerves
External anal sphincter is under ___ control while internal anal sphincter is under ___ control
. Voluntary
. Involuntary
Differences in muscle type in internal and external anal sphincters
. Internal is extension of muscular coat of rectal wall
. External is strained muscle under voluntary control
Function of anal sphincter
Hold anal canal closed
Anorectal junction (pectinate/dentate line)
Serrated line btw anal canal and rectum
. Boundary btw somatic and visceral nerve supplies
Rectum location
. From rectosigmoid junction ant. To S3 vertebra to anorectal junction at tip of coccyx
Appearance of external margin of anal canal
Moist hairless different from surrounding perinatal skin
Rectum characteristics
. 12 cm long
. Rectal ampulla store flatus/feces
. Wall has 3 transverse fold (Houston valves)
. Prox. End is continuous w/ sigmoid colon
. Ant. Side lies in contact w/ vagina in females (rectovaginal septum) and against prostate gland in males
Prostate characteristics
. Round, heart shaped
. 2.5 cm long
. Surround urethra ant. To bladder
. Inc. 5x in size btw puberty and end of teen yrs
What parts of prostate are palpable on exam?
. Lat. lobes and median sulcus
Nonpalpable parts of prostate
. Ant. And central areas
. Seminal vesicles above prostate
Important ROS for prostate
. Freq/urgent need to urinate
. Inc. Freq. of urination at night (nocturia)
. Difficulty starting urination
. Weak urine stream/stream that stops and starts
. Dribbling at end of urination
. Straining while urinating
. Inability to completely empty bladder
Prostate cancer
. Most frequently diagnosed non skin cancer
. Second leading cause of cancer death in men
.
PSA
Prostate-specific-antigen
Screening tool
Risk of prostate cancer rates from 1985 and now
Inc. from 9% to 15%
Lifetime risk of dying from prostate cancer
3%
Risk factors for prostate screening
. Age (>50, med. age of diagnosis 66)
. Ethnicity (AA highest incident and mortality rate, higher % diagnosed before 50, present w/ more advance stage)
. Family history (1 1st degree relative inc. chance 2 fold, 2/3 1st degree inc. risk 5-11 fold, BRCA1/2)
. Agent orange exposure
. Diets high in animal fat
. Obesity
. Smoking
T/F BPH is risk factor for prostate cancer
F, it is NOT
Patient positioning for rectal exam
. Laying of left side
. Hips and knees flexed
. Do after female genitalia exam in lithotomy position
. Keep patient draped as much as possible
Things to note during rectal exam
. Sphincter tone
. Tenderness
. Induration (area of firmness/dimpled)
. Irregularities or nodules
What can cause inc. sphincter tone
. Anxiety
. Inflammation
. Scarring
What can cause dec. in sphincter tone
. Neurologic diseases/spinal cord lesions
What can cause induration?
. Inflammation
. Scarring
. Malignancy
Things to note when examining prostate
. Size . Shape . Consistency . Nodules . Tenderness
Pilonidal cyst
. Usually idiopathic
. May have drainage
. Concern for abscess formation
. Might have little hair tuft on it
External hemorrhoids
. Dilated hemorrhoid veins below pectinate line
. Thrombosis causes pains
Internal hemorrhoids
Enlargement of vascular cushion above pectinate line
. May cause bright red bleeding
. Can prolapse (get larger and move it external side of anal canal), gets worse w/ straining and can be larger if it involves entire bowel
Anal fissure
. Painful
. Ulceration of anal canal
. May have sentinel tag below it
Anorectal fistula
. Tract that opens at one end into the anaconda/rectum and into the skin at the other end
Polyps of rectum
. Common
. Difficult to palpate
. Soft, usually benign
. Biopsied upon colonoscopy
Cancer of the rectum
. Firm
. Nodular
. Rolled edges
. Biopsied
Rectal shelf
. Sign of peritoneal metastasis
. Firm.hard nodular area
. Can be hard to distinguish from nodule inside actual canal
Prostatitis
. Tender, swollen, boggy
. Consider Neisseria gonorrhea and Chlamydia trachomatis in men <35
Prostate cancer feeling on exam
Area of hardness/nodularity
BPH feeling on exam
. Enlargement
Common diagnostic tests done when patient has frequent urination
. Thorough history . Pregnancy test . Urinalysis . BMP . PSA . Post void residual testing . Renal imaging . Voiding diary
Urinalysis
Evaluates for infection, glucose in urine
. Most common in primary care
BMP in relation of frequency urination
. Screens for diabetes
. Assesses renal function
. Checks electrolytes
Post void residual testing
. Screen for BPH or prostate cancer
Renal imaging
Checks for anatomic abnormalities or kidney stones
Functional incontinence
. Person unable to get to bathroom for any reason
. Occurs in physically/mentally handicapped patients
. Patients w/ dementia
. Treatment: environmental modification (bedside commodes)
Diagnostics/labs for dementia
. Depression screening . Thyroid testing . Electrolytes . Thiamine . Vit. B12 . Electrolytes . Brain imaging
