urinary incontinenc

Question 1

incontinence

Answer 1

involuntary loss of urin

Question 2

what is normal physiology of urine release?

Answer 2

normally, sympathetic tone closes the bladder neck and increases pelvic floor tone–> during micturition, parasympathetic tone increases, allowing bladder neck relaxation

Question 3

what are the types of urinary incontinence?

Answer 3

stress, urge, and overflow

Question 4

what is stress incontinence?

Answer 4

urine leakage due to increased intra-abdominal pressure

*rare in men

Question 5

PP of stress?

Answer 5

increased intra-abdominal pressure > urethral resistance to urine flow

laxity of pelvic floor muscles; childbirth, surgery, postmenopausal estrogen loss, post-prostatectomy

Question 6

s/sx of stress incontinence

Answer 6

increased intra-abdominal pressure from sneezing, coughing, laughing leads to urine leakage

*worse when upright

Question 7

tx of stress incontinence?

Answer 7

pelvic floor exercises (87% improvement)

Question 8

medications for stress?

Answer 8

alpha agonists: midodrine and pseudophedrine

estrogents: cream or estradiol-impregnated vaginal ring

Question 9

what is the moa of AA?

Answer 9

increases urethral outlet resistance–> including artificial sphincter

Question 10

what is the surgical tx benefit for stress?

Answer 10

increases urethral outlet resistance, including artificial sphincter

Question 11

what are anti-incontinence devices?

Answer 11

vag cones that help stregthen the pelvic floor muscles

Question 12

urge incontinence?

Answer 12

urine leakage accompanied or proceeded by urge

Question 13

PP of urge I

Answer 13

• Detrusor muscle overactivity–> involuntary contraction

- overactive bladder- detrusor muscle stimulated by muscarinic acetylcholine receptors

Question 14

s/sx of urge incontinence?

Answer 14

urgency, frequency, small volume voids, nocturia

Question 15

tx of urge (non-pharmaceutical)

Answer 15

bladder training- can lead to a 75% improvemtn

• timed frequent voiding, decreased fluid intake

Question 16

pharmaceutical tx for urge?

Answer 16

1) anticholinergics
2) TCA
3) Mirabegron

Question 17

what is the first line medical tx for urge incontinence?

Answer 17

anticholinergics

oxybutynin: antispasmodic and anticholinergic
tolterodine

Question 18

what is the MOA of anticholinergics?

Answer 18

blocks cholinergic receptors in the bladder, which increases bladder capacity and the volume threshold for initiating involuntary contraction

Question 19

what are the side effects of anticholinergics?

Answer 19

dry mouth, constipation, dry eyes, blurred vision, increased heart rate

Question 20

how to TCA work in urge incontinence?

Answer 20

central and peripheral anticholinergic effect and aa agonist–> bladder muscle relaxation, increases bladder outlet resistance, antispasmodic effect on detrusor muscle and increased urethral sphincter tone

Question 21

what is mirabegron?

Answer 21

B3 agonist: bladder relaxant

Question 22

what are surgerical tx for urge incontinence?

Answer 22

injection of botox, bladder augmentation

Question 23

what pt education can you give someone with urge incontinence regarding their diet?

Answer 23

avoid spicy foods, citrus fruits, chocolate, caffeine

Question 24

what is overflow incontinence?

Answer 24

urinary retention: incomplete bladder emptying

Question 25

PP of overflow

Answer 25

decreased detrusor muscle activity- atony

“underactive bladder” due to DM, MS, autonomic dysfxn, spinal injury

-Bladder outlet obstruction–> BPH

Question 26

s/sx of overflow?

Answer 26

small volume voids, frequency, dribbling

increased post-void residual > 200 ml

Question 27

first line tx of overflow?

Answer 27

intermittent or indwelling catheter

Question 28

what meds can be used to tx overflow?

Answer 28

1) cholinergics: bethanechol

2) BPH: alpha 1 blockers: tamulosin

Question 29

how does bethanechol work?

Answer 29

increases detrusor muscle activity

Question 30

how does tamsulosin work?

Answer 30

relaxes the smooth muscle of the prostate and bladder neck, which helps decrease urethral resistance and obstruction