Urinary Frequency Flashcards by Emily Mosher

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

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How aging affects GU system in specifically men and what results?

Enlarged prostate causing urinary incontinence/urgency/ or dribbling due to BPH

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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

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Basic activities of daily living

. Eating
. Bathing/toileting
. Ambulating
. Dressing
. Maintaining personal hygiene

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Instrumental activities of daily living

. Managing finances
. Managing transportation
. Preparing food
. Shopping
. Managing meds
. Housekeeping

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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

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Urge incontinence

. Detrusor (smooth muscle under ANS) overactivity
. Causes uninhibited bladder contractions
. Most common
. Idiopathic
. Treatment: schedule voiding and other behavioral exercises

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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

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Urethral obstruction

. Prostatic enlargement, urethal stricture, bladder neck contracture, prostate cancer
. Outflow obstruction

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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

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Metabolic issues causing urinary frequency

. Diabetic ketoacidosis (poorly controlled diabetes causing osmolar diuresis)

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Infections that can cause urinary frequency

. STD
. UTI
. Cystitis

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Anatomical reasons that could cause urinary frequency

. Benign prostate hyperplasia (BPH)

. Bladder malignancy/Prostate malignancy

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Polyuria

Urine output higher than 3L per day

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T/F urinary frequency can exist w/o polyuria

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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)

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Muscles of anal canal

. External and internal anal sphincter

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Where does angle of anal canal lie?

Line between anus and umblilicus

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What nerve supply goes to anal canal?

Somatic sensory nerves

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External anal sphincter is under ___ control while internal anal sphincter is under ___ control

. Voluntary

. Involuntary

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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

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Function of anal sphincter

Hold anal canal closed

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Anorectal junction (pectinate/dentate line)

Serrated line btw anal canal and rectum

. Boundary btw somatic and visceral nerve supplies

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Rectum location

. From rectosigmoid junction ant. To S3 vertebra to anorectal junction at tip of coccyx

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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

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 ```