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body, function and pharmacology > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

define urinary incontinence (UI)

A

any involuntary leakage of urine

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2
Q

define nocturnal enuresis

A

any involuntary loss of urine during sleep

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3
Q

define urgency in UI

A

complaint of sudden, compelling desire to pass urine; difficult to defer

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4
Q

define nocturia

A

waking at night to void

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5
Q

define retention in UI

A

inability to urinate

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6
Q

what are some of the risks of poor UI management

A
  • urinary tract infection
  • rashes, skin infections
  • pressure ulcers
  • social isolation, depression
  • sleep disturbances
  • falls
  • others
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7
Q

describe the normal process of voiding and the associated body parts

A
  • bladder relaxes and stretches as it’s being filled
  • sphincter contracts to prevent leakage
  • pelvic floor supports the bladder and aids sphincter
  • nervous system transmit message to brain -> commands
  • sphincter relaxes while bladder contracts to urinate
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8
Q

which adrenergic receptors are linked to..

a) bladder control
b) sphincter control

A

a) beta-adrenergic receptors

b) alpha-adrenergic receptors

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9
Q

what are some general risk factors for UI? What are some specific to women and what are some specific to men?

A
  • smoking
  • obesity
  • constipation
  • increased risk of UI
  • co-morbidities: stroke, PD, dementia, sleep apnoea, diabetes, depression

wmn: pregnancy, childbirth, menopause, pelvic surgery
men: prostate surgery

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10
Q

what are some age-related changes in the body that increases risk of UI?

A
  • decrease in elastin that reduces bladder capacity
  • delayed sensations from the body
  • decrease ability to postpone urination
  • incomplete emptying
  • increase involuntary bladder contractions
  • post-menopause atrophic changes
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11
Q

list the 5 types of incontinence

A
  • stress UI
  • urge UI
  • overflow UI
  • functional incontinence (lack of recognition or ability to get to toilet on time)
  • mixed incontinence
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12
Q

explain stress incontinence, it’s pathophysiology and risk factors

A
  • uncontrollable loss of small amounts of urine on exertion (coughing, sneezing, straining)
  • increase in abdominal pressure and weakness in urinary sphincter or pelvic floor
  • childbirth; pelvic surgery; lack of oestrogen; obesity
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13
Q

what are some non-drug management methods of stress UI?

A
  • pelvic floor exercises (2-3 months)
  • treat constipation
  • treat chronic coughs
  • weight loss
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14
Q

what are some drug thx for treating stress UI? Which one is the best of stress UI? What other methods can be used to treat stress UI?

A
  • alpha-adrenergic agonists
  • duloxetine (serotonin norepinephrine reuptake inhibitor), is an antidepressant but used for stress UI
  • vaginal oestrogens
  • surgical: improve closure of sphincter or support bladder neck
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15
Q

explain urge incontinence, it’s pathophysiology and risk factors

A
  • urine loss preceded by urgency
  • over-active bladder activity; no clear cause
  • PD, MS, stroke, constipation, enlarged prostate, UTIs, age-related changes
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16
Q

what are some non-drug management options for urge UI?

A
  • control bladder (training)
  • drink more water, reduce tea, coffee, cola, alcohol
  • avoid constipation
  • weight loss
    exclude UTI
17
Q

anticholinergics have been indicated in treating urge UI. Explain the MOA, how it helps, any AEs and provide an example drug

A
  • MOA: inhibits Ach from inducing involuntary detrusor contractions. Main target is M3 receptors in urinary tract
  • AEs: dry mouth, constipation, blurred vision, urinary retention
  • Oxybutynin: 2.5-5mg/day
18
Q

what are alternative thx for urge UI? What are the pros and cons?

A
  • botulinum toxin injections into bladder wall. Repeated dosage, may lead to incomplete bladder emptying
  • neurostimulation to modulate bladder nerve supply: cost effective?
  • Mirabegron: targets B3 adrenoreceptor, increases urinary storage capacity (25-50mg once daily); may increase BP, HR, UTI, Naso infection risk
19
Q

explain overflow incontinence, it’s pathophysiology, symptoms and health risk issues associated with overflow UI

A
  • under-active bladder with poor contraction resulting in incontrollable leakage of small amounts of urine
  • symptoms: frequency, urgency, nocturia, UTIs, ‘dribbling’, incomplete bladder emptying
  • health risks: enlarge prostate, constipation (may be drug related), neurogenic bladder
20
Q

what are some management methods of dealing with overflow UI?

A
  • review medications
  • catherisation
  • surgery
  • if Benign prostatic hyperplasia (BPH) is cause, treat BPH
21
Q

explain functional incontinence, what it is associated with and management tactics

A
  • loss of urine due to inability and/or unwillingness to go to toilet
  • Assoc. immobility, loss of mental function
  • management: regular toilet assistance, remind/schedule voiding, pads

body, function and pharmacology (7 decks)

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