Urinary Incontinence Flashcards
What is urinary incontinence?
Involuntary leakage of urine
Transient UI
Sudden onset with duration < 6 months that is reversible
What are the 4 types of Chronic UI?
Stress
Urge
Mixed
Overflow
When does Stress Chronic UI occur and more often in what gender?
With coughing, sneezing, or exertion
– WOMEN
What is Urge Chronic UI?
Sudden compelling desire to void
Mixed Chronic UI is the coexistence of both?
Stress and Urgency
What is Overflow Chronic UI?
Urinary retention (full bladder) due to detrusor underactivity or outflow obstruction that causes urine to leak out
In what gender is Overflow Chronic UI more common and why?
MALES
– Benign Prostatic Hypertrophy
Functional UI
Physical/cognitive impairment limits ability to process information about the bladder fullness
What are 2 risk factors for UI specific to women?
Parity - pregnancies
Menopause
What is 1 risk factor for UI specific for men?
BPH
What are some common risk factors for UI?
Age Obesity Smoking Meds Neuro issues
With a stress UI, what are the main contributors to the pathophysiology?
Pelvic floor musculature
External sphincter
Endopelvic fascia
Urethra
With an urge UI, what is the main contributor to the pathophysiology?
Detrusor muscle
What is Overflow Chronic UI?
Bladder is full and distended so urine leaks out
What are some common causes of Overflow Chronic UI?
BPH Blocked urethra/bladder weakness Diabetes Alcohol Decreased nerve function
With the physical exam, mental status, abdominal exam and urogenital exam are all checked. Describe the Q tip test.
- Q tip inserted into bladder
- patient performs valsalva maneuver *
(+) test = > 30 degree change in angle of urethra that shows hypermobility
- patient performs valsalva maneuver *
What diagnostic can rule out UTI, hematuria, proteinuria, and glucosuria?
UA with calorimetric reagent test + microscopy
What are some other diagnostic tests you can do?
Urine culture
Post-Void Residual Volume
Voiding Diaries
24 hours Pad Testing
What is an abnormal result of a Post Void Residual Volume diagnostic test?
> 200 ml
What is abnormal result of a 24 hour Pad Testing diagnostic test?
> 4g increase in weight
For a transient UI, what should you do for the treatment?
Rule out reversible causes
– DIPPERS
DIPPERS
Delirium Infection Pharmaceuticals Psych Excess fluid intake Restricted mobility Stool impaction
Treatment for Stress UI?
Conservative management
- Appropriate fluids, strengthen pelvic floor, weight loss, smoking cessation, etc.
Treatment for Urge UI?
Pharmacologic
- Antimuscarinics, intravaginal estrogen, mirabegron
What are 2 invasive options for the treatment of Urge UI?
Neuromodulation
Intravesical Botox
Treatment for Overflow UI?
Pharmacologic
- Alpha Adrenergic Antagonists
What are some complications of UI?
- Poor quality of life
- Increased depression due to isolation, etc.
- (-) psychological burden on caregivers
Alpha Adrenergic Antagonists can treat what type of UI?
Overflow UI
Antimuscarinics, intravaginal estrogen or Mirabegron can treat what type of UI?
Urge UI
