Urinary Incontinence Flashcards
There are three ways to classify urinary incontinence. What are they?
transient, chronic, and functional UI
how is transient UI defined?
it arises suddenly, lasts less than 6 months, and it can be reversed
what are the subtypes of chronic UI?
stress UI, urge UI, mixed UI, and overflow UI
what is stress UI?
with coughing, sneezing, or physical exertion
what is urge UI?
with sudden compelling desire to void
what is mixed UI?
coexistence of stress and urgency UI
what is overflow UI?
urinary retention from detrusor underactivity or outflow obstruction
what is functional UI?
physical or cognitive impairment limits mobility or ability to process information about bladder fullness
what are the risk factors for women getting UI?
parity and menopause
what are the risk factors for men getting UI?
BPH
what plays a role in stress incontinence?
the urethra is more mobile because you lose support of the bladder neck and urethra–> the pelvis floor muscles and ligaments lose strength so there is more motion
what should the physical exam look like in a patient with UI? (3 main components of a UI workup)
functional assessment: mental status, mobility, BMI; abdominal exam: assess for masses, palpable bladder, CVA tenderness; urogenital exam
what is the cotton swab test?
there should be less than a 30 degree change when the patient cough; if you see more then that is consistent with urethral hypermobility
what are the urological tests you would order for a patient with UI?
UA with calorimetric reagent test +microscopy +/- post-void residual volume; voiding diaries; pad testing
what makes a pad test positive?
greater than a 4 g increase in weight of the pad after 24 hours
when are urodynamic studies valuable?
if incontinence diagnosis is uncertain after initial assessment; if symptoms do not correlate with physical findings; if previous treatment failed; DO NOT DO THIS IN THE INITIAL WORKUP
what things does a urodynamic study measure?
the filling volume, the intravesical pressure, the detrusor pressure, the abdominal pressure, and the flow rate
what can be said about the bladder function and neurologic control of urination in functional UI?
bladder function or neurologic control of urination are normal in functional UI
how can functional UI be addressed/managed?
by providing alternative receptacles (male urinal) or planning to void without waiting for the bladder to be as full
there is a mnemonic that helps us remember reversible causes of UI. What is it and what does it stand for?
DIPPERS: Delirium Infection (acute UTI) Pharmaceuticals Psychological morbidity Excess fluid intake/ urine output Restricted mobility Stool impaction
what is important to remember to do during the management of any case of UI?
you need to periodically reconsider the goals and preferences of management
what is the recommended conservative management for stress incontinence?
appropriate fluid intake, constipation management, electrical stimulation, mechanical devices, pelvic floor muscle strengthening, smoking cessation, and weight loss
what are the pharmacologic ways we treat urge incontinence?
antimuscarinics, intravaginal estrogen, and mirabegron
what is the pharmacologic ways we treat overflow UI?
alpha-adrenergic antagonists
how would you describe treatment of UI?
a step wise approach- you start with the more conservative management and then escalate to medications and physical devices and then surgical intervention if needed
what are some examples of non-surgical devices that can be used to treat UI?
pessaries, external or internal catheters, penile clamps in men
when is it appropriate to use vaginal estrogen in cases of UI?
for women with urogenital atrophy and LUTS
when are anticholinergic drugs used for UI?
for urge incontinence (they act directly on detrusor muscle to decrease overactive bladder)
when are b3-adrenergic agonists used in the treatment of UI?
for urge incontinence- for women with contraindications
what drugs are the most commonly used for UI?
anti-muscarinics
which class of drugs are preferred for UI due to their fewer adverse effects?
selective M3 antimuscarinics- but they are expensive
what is the problem with the anti-muscarinics used for UI?
there are a lot of adverse effects, so for this reason they are not first-line therapy for geriatric patients
what are 3 invasive interventions for UI?
stress incontinence surgery, neuromodulation for urge UI, intravesical onabotulinumtoxin A for urge UI (botox)
