Urinary incontinence Flashcards
define urinary incontinence (UI)
any involuntary leakage of urine
define nocturnal enuresis
any involuntary loss of urine during sleep
define urgency in UI
complaint of sudden, compelling desire to pass urine; difficult to defer
define nocturia
waking at night to void
define retention in UI
inability to urinate
what are some of the risks of poor UI management
- urinary tract infection
- rashes, skin infections
- pressure ulcers
- social isolation, depression
- sleep disturbances
- falls
- others
describe the normal process of voiding and the associated body parts
- 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
which adrenergic receptors are linked to..
a) bladder control
b) sphincter control
a) beta-adrenergic receptors
b) alpha-adrenergic receptors
what are some general risk factors for UI? What are some specific to women and what are some specific to men?
- 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
what are some age-related changes in the body that increases risk of UI?
- 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
list the 5 types of incontinence
- stress UI
- urge UI
- overflow UI
- functional incontinence (lack of recognition or ability to get to toilet on time)
- mixed incontinence
explain stress incontinence, it’s pathophysiology and risk factors
- 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
what are some non-drug management methods of stress UI?
- pelvic floor exercises (2-3 months)
- treat constipation
- treat chronic coughs
- weight loss
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?
- 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
explain urge incontinence, it’s pathophysiology and risk factors
- urine loss preceded by urgency
- over-active bladder activity; no clear cause
- PD, MS, stroke, constipation, enlarged prostate, UTIs, age-related changes
what are some non-drug management options for urge UI?
- control bladder (training)
- drink more water, reduce tea, coffee, cola, alcohol
- avoid constipation
- weight loss
exclude UTI
anticholinergics have been indicated in treating urge UI. Explain the MOA, how it helps, any AEs and provide an example drug
- 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
what are alternative thx for urge UI? What are the pros and cons?
- 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
explain overflow incontinence, it’s pathophysiology, symptoms and health risk issues associated with overflow UI
- 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
what are some management methods of dealing with overflow UI?
- review medications
- catherisation
- surgery
- if Benign prostatic hyperplasia (BPH) is cause, treat BPH
explain functional incontinence, what it is associated with and management tactics
- 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
