Urinary Incontinence Flashcards
Risk factors: Medications
- Estrogen blockers; alpha blockers; cholinesterase inhibitors
- Meds that can affecte the urinary tract functions
- Polyuria, frequency, urgency: diuretics, ETOH
- Urethral relaxation can be caused by alpha blockers causing worsening stress incontinence
- Urinary retention can be seen with anticholinergics, CCB, narcotics, and antipsychotics
Urge Urinary Incontinence
Suggest detrusor overactivity PLUS impaired compensatory mechanisms
- Idiopathic, age-related, secondary to lesions in cerebral and spinal pathways
- Due to bladder outlet obstruction or bladder irritation (infection, stones, tumor)
- Occurs with urgency: sudden need to void; most common in both men and women
UI and Stress UI
- Damage to the pelvic floor supports and sphincter failure
- Leakage associated with coughing, sneezing, laughing, and physical activity
- Second most common form in women
- Seen in men after prostectomy
Mixed UI
Leakage occurs with both urgency and activity
- Seen in women
- Mixed is typically focused on treating the patients worst symptoms first-lifestyle modifications, and medical therapy; surgery to improve stress UI
Meds associated w/ UI
- Alcohol
- Alpha adrenergic agonists
- ACEi
- Anticholinergics
- Alpha adrenergic blockers
- CCB
- Antipsychotics
- estrogen
- cholinesterase inhibitors
- Loop diuretics
- Narcotics and NSAIDS
- TCA
- Sedative hypnotics
- Gabapentin
- Thiazolidediones
UI Red flags
- Abrupt onset
- Pelvic pain
- Hematuria
Persistent types of UI
- Stress
- Urge
- Mixed (stress and urge)
- Overflow
- Functional
Stress UI
- Loss of urine due to pressure on the bladder exceeding ability of sphincter to control
- Causes: relative incompetence of sphincter, weakness of supporting structures, malposition of bladder/urethra
Stress UI Symptoms
Leakage of small amounts of urine with laughing, physical activity, sneezing, coughing
- Rarely occurs at night
- In men only after urethral manipulations (e.g prostate surgery)
Tx for Stress UI
- Behavioral
- Pharm: alpha agonists such as pseudephedrine. Low dose tricyclics (imipramine), estrogens (postmenopausal)
- Surgical: Pessaries. Bladder neck suspension. Injections of collagen
- Products-padding
Goal of tx for Stress UI
-Stimulate adrenergic receptors in the bladder neck smooth muscle, enhance micturition reflex
Stress UI Meds: Duloxetine
- Inhibits serotonin and NE reuptake
- S/E: nausea, HA, insomnia, dry mouth
- Not FDA approved
Stress UI Meds: Alpha Adrenergic agonists
- Enhance micturition reflect by activating alpha adrenergic receptors
- S/E: HTN, HA, dry mouth, nausea, insomnia
- DO not use in those with uncontrolled HTN, CAD, hyperthyroidism, renal failure, narrow angle glaucoma
Stress UI Meds: Estrogen
- Increases urethral epithelium proliferation
- Topical use only
- limited side effects give topical
- typically use if vaginal atrophy is present
Urge UI
- Involuntary loss of urine due to uncontrolled contraction of bladder with and without warning
- Causes: GU changes of aging
- –Irritative/neurologic condition,such as infections, diabetes mellitus, bladder stones, tumors, stroke or dementia, and increased intra-abdominal pressure changes
S/S of Urge UI
- losses of variable (often large) amounts
- little or no warning time
- associated frequency
- occurs both day and night
Urge Behavioral tx
- Bladder training
- Kegal exercises
- prompted voiding, schedule voiding
- biofeedback
- Electrical stimulation
Urge UI Med: Antimuscarinic
-Oxybutynin (Ditropan or Oxytrol)
-Tolterodine (Detrol)
-Trospium (Sanctura)
-Solifenacin
-Darifencacin
-Fesoterodine
S/E include: dry mouth, constipation, dizziness, blurred vision, potential drug to drug interactions with other anticholinergics
Avoid using antimuscarinics
- Advanced dementia
- Gastric or urinary retention
- Uncontrolled narrow glaucoma
Urge UI meds: Mirabegron
- beta 3 adrenergic agonist
- goal is to decrease incontintent episodes
- adverse: htn, nasopharyngitis, UTIs and QTc prolongation. Higher cost
Urge UI meds: Tricyclic antidepressants (alternative)
- TCAs are no more effective than oxybutynin IR
- Imipramine, doxepine, notriptyline
- Adverse: Orthostatic Hotn, cardiac conduction abnormalities, dizziness, confusion
Urge UI Meds: Botulinium toxin A (alternative)
- for select patients who’ve failed first and second line therapies and/or those who have detrusor overactivity due to neuro conditions
- -Paralyzes the muscle by preventing the release of acth into the synapse. Effects last 4-8 months
Overflow UI
Unpredictable involuntary losses of urine due to overdistention of the bladder
- Obstructive: prostate hypertrophy; urethral stenosis
- Neurogenic; spinal cord injury, neuropathy
Tx of Overflow UI
- Surgical interventions
- neurogenic: cholinergic drugs e.g bethanechol (urecholine) rarely effective
- Intermittent catheters
Functional UI
Inappropriate urination despite normally functioning bladder and sphincter
-Causes: cognitive or emotional, dementia, behavioral strokes, arthritis, restraints
