urinary incontinenc Flashcards
incontinence
involuntary loss of urin
what is normal physiology of urine release?
normally, sympathetic tone closes the bladder neck and increases pelvic floor tone–> during micturition, parasympathetic tone increases, allowing bladder neck relaxation
what are the types of urinary incontinence?
stress, urge, and overflow
what is stress incontinence?
urine leakage due to increased intra-abdominal pressure
*rare in men
PP of stress?
increased intra-abdominal pressure > urethral resistance to urine flow
laxity of pelvic floor muscles; childbirth, surgery, postmenopausal estrogen loss, post-prostatectomy
s/sx of stress incontinence
increased intra-abdominal pressure from sneezing, coughing, laughing leads to urine leakage
*worse when upright
tx of stress incontinence?
pelvic floor exercises (87% improvement)
medications for stress?
alpha agonists: midodrine and pseudophedrine
estrogents: cream or estradiol-impregnated vaginal ring
what is the moa of AA?
increases urethral outlet resistance–> including artificial sphincter
what is the surgical tx benefit for stress?
increases urethral outlet resistance, including artificial sphincter
what are anti-incontinence devices?
vag cones that help stregthen the pelvic floor muscles
urge incontinence?
urine leakage accompanied or proceeded by urge
PP of urge I
- Detrusor muscle overactivity–> involuntary contraction
- overactive bladder- detrusor muscle stimulated by muscarinic acetylcholine receptors
s/sx of urge incontinence?
urgency, frequency, small volume voids, nocturia
tx of urge (non-pharmaceutical)
bladder training- can lead to a 75% improvemtn
- timed frequent voiding, decreased fluid intake
pharmaceutical tx for urge?
1) anticholinergics
2) TCA
3) Mirabegron
what is the first line medical tx for urge incontinence?
anticholinergics
oxybutynin: antispasmodic and anticholinergic
tolterodine
what is the MOA of anticholinergics?
blocks cholinergic receptors in the bladder, which increases bladder capacity and the volume threshold for initiating involuntary contraction
what are the side effects of anticholinergics?
dry mouth, constipation, dry eyes, blurred vision, increased heart rate
how to TCA work in urge incontinence?
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
what is mirabegron?
B3 agonist: bladder relaxant
what are surgerical tx for urge incontinence?
injection of botox, bladder augmentation
what pt education can you give someone with urge incontinence regarding their diet?
avoid spicy foods, citrus fruits, chocolate, caffeine
what is overflow incontinence?
urinary retention: incomplete bladder emptying
PP of overflow
decreased detrusor muscle activity- atony
“underactive bladder” due to DM, MS, autonomic dysfxn, spinal injury
-Bladder outlet obstruction–> BPH
s/sx of overflow?
small volume voids, frequency, dribbling
increased post-void residual > 200 ml
first line tx of overflow?
intermittent or indwelling catheter
what meds can be used to tx overflow?
1) cholinergics: bethanechol
2) BPH: alpha 1 blockers: tamulosin
how does bethanechol work?
increases detrusor muscle activity
how does tamsulosin work?
relaxes the smooth muscle of the prostate and bladder neck, which helps decrease urethral resistance and obstruction
