Urinary Incontinence Flashcards
Urge urinary incontinence vs Stress urinarcy incontinence
Urge = a sudden urge to urinate due to neuropathy
common causes: DM, stroke, dementia, PD, multiple sclerosis
Stress = urine leaks from exertion (laughing, exercise, sneezing)
**can also have mixed with both (:
What is urinary incontinence?
involuntary leakage of urine
The pathophys
the bladder is surrounded by detrusor muscle that is innervated by parasympathetic nerves (ACh acting on muscarinic), but the internal sphincter is innervated by the sympathetic nervous system
M3 is known for involuntary bladder constraction on detrusor muscle
Risk factors
Age > 40years
Diabetes
Prior vaginal delivery
Obesity
Neurologic conditions (PD, stroke, dementia)
Drugs that increase incontinence (alcohol, cholinesterase inhibitors, diuretics, sedatives)
Non pharm treatment
pelvic floor muscle exercises
fluid management
avoiding caffeine
What is 1st line treatment for urge incontinence?
Oxybutynin (anticholinergic)
or mirabegron (beta-3 agonist)
*adequate trial of 4-8 weeks for each drug before switching or adding 2nd therapy
What is 2nd line for urge incontinence?
Onabotulinumtoxin A (Botox) injection
higher efficacy but is $$$$
Ditropan XL
Oxybutynin ER
CI: uncontrolled narrow angle gluacoma
Warning: agitation, confusion, drowsiness, blurred vision
Caution if performing a task that requires alertness
SE: dizziness, drowsiness!!!!!, xerostomia, constipation ^anticholinergic side effects!!! angioedema
*OROS formulation = ghost tablet
Oxytrol
Oxybutynin patch
*less dry mouth and constipation (:
Still a lot of drowsiness and dizziness!!!!
Detrol
Tolterodine
CI: uncontrolled narrow angle gluacoma
Warning: agitation, confusion, drowsiness, blurred vision
Caution if performing a task that requires alertness
SE: dizziness, drowsiness!!!!!, xerostomia, constipation ^anticholinergic side effects!!!
angioedema
Vesicare
Solifenacin
CI: uncontrolled narrow angle gluacoma
Warning: agitation, confusion, drowsiness, blurred vision
Caution if performing a task that requires alertness
SE: dizziness, drowsiness!!!!!, xerostomia, constipation ^anticholinergic side effects!!!
angioedema
What is the biggeset reason patients cannot tolerate anticholinesterase therapy for urinary incontinence?
Xerostomia (dry mouth)
-switch to patch or gel formulation of oxybutynin
Beta-3 agonists
Mirabegron
Vibegron
***relax the detrusor muscle
Warning: urinary retention in BPH patients, HYPERTENSION
**no dry mouth (:
What is a noctural urinary incontinence treatment?
Demopressin -antidiuretic hormone
BW: hyponatremia
