Urinary Incontinence

Question 1

What is urinary incontinence?

Answer 1

Involuntary leakage of urine

Question 2

Transient UI

Answer 2

Sudden onset with duration < 6 months that is reversible

Question 3

What are the 4 types of Chronic UI?

Answer 3

Stress
Urge
Mixed
Overflow

Question 4

When does Stress Chronic UI occur and more often in what gender?

Answer 4

With coughing, sneezing, or exertion

– WOMEN

Question 5

What is Urge Chronic UI?

Answer 5

Sudden compelling desire to void

Question 6

Mixed Chronic UI is the coexistence of both?

Answer 6

Stress and Urgency

Question 7

What is Overflow Chronic UI?

Answer 7

Urinary retention (full bladder) due to detrusor underactivity or outflow obstruction that causes urine to leak out

Question 8

In what gender is Overflow Chronic UI more common and why?

Answer 8

MALES

– Benign Prostatic Hypertrophy

Question 9

Functional UI

Answer 9

Physical/cognitive impairment limits ability to process information about the bladder fullness

Question 10

What are 2 risk factors for UI specific to women?

Answer 10

Parity - pregnancies

Menopause

Question 11

What is 1 risk factor for UI specific for men?

Answer 11

BPH

Question 12

What are some common risk factors for UI?

Answer 12

Age
Obesity
Smoking
Meds
Neuro issues

Question 13

With a stress UI, what are the main contributors to the pathophysiology?

Answer 13

Pelvic floor musculature
External sphincter
Endopelvic fascia
Urethra

Question 14

With an urge UI, what is the main contributor to the pathophysiology?

Answer 14

Detrusor muscle

Question 15

What is Overflow Chronic UI?

Answer 15

Bladder is full and distended so urine leaks out

Question 16

What are some common causes of Overflow Chronic UI?

Answer 16

BPH
Blocked urethra/bladder weakness
Diabetes
Alcohol
Decreased nerve function

Question 17

With the physical exam, mental status, abdominal exam and urogenital exam are all checked. Describe the Q tip test.

Answer 17

• Q tip inserted into bladder
• • patient performs valsalva maneuver *
    (+) test = > 30 degree change in angle of urethra that shows hypermobility

Question 18

What diagnostic can rule out UTI, hematuria, proteinuria, and glucosuria?

Answer 18

UA with calorimetric reagent test + microscopy

Question 19

What are some other diagnostic tests you can do?

Answer 19

Urine culture
Post-Void Residual Volume
Voiding Diaries
24 hours Pad Testing

Question 20

What is an abnormal result of a Post Void Residual Volume diagnostic test?

Answer 20

> 200 ml

Question 21

What is abnormal result of a 24 hour Pad Testing diagnostic test?

Answer 21

> 4g increase in weight

Question 22

For a transient UI, what should you do for the treatment?

Answer 22

Rule out reversible causes

– DIPPERS

Question 23

DIPPERS

Answer 23

Delirium
Infection
Pharmaceuticals
Psych
Excess fluid intake
Restricted mobility
Stool impaction

Question 24

Treatment for Stress UI?

Answer 24

Conservative management

- Appropriate fluids, strengthen pelvic floor, weight loss, smoking cessation, etc.

Question 25

Treatment for Urge UI?

Answer 25

Pharmacologic

- Antimuscarinics, intravaginal estrogen, mirabegron

Question 26

What are 2 invasive options for the treatment of Urge UI?

Answer 26

Neuromodulation

Intravesical Botox

Question 27

Treatment for Overflow UI?

Answer 27

Pharmacologic

- Alpha Adrenergic Antagonists

Question 28

What are some complications of UI?

Answer 28

• Poor quality of life
• Increased depression due to isolation, etc.
• (-) psychological burden on caregivers

Question 29

Alpha Adrenergic Antagonists can treat what type of UI?

Answer 29

Overflow UI

Question 30

Antimuscarinics, intravaginal estrogen or Mirabegron can treat what type of UI?

Answer 30

Urge UI