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Women's Health Clin med > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

What is urinary incontinence

A

near constant dribbling / intermittent voiding with / without awareness of the need to void

extreme urgency w little to no warning

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2
Q

What is the most common type of urinary incontinence in elderly

A

urge incontinence

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3
Q

What are the different types of urinary incontinence

A

Urge incontinence
stress incontinence
overflow incontinence
functional incontinence
Mixed incontinence

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4
Q

What is urge incontinence

A

Uncontrolled urine leakage immediately after urgent, irrepressible need to void

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5
Q

What exacerbates urge incontinence

A

use of diuretics and the inability ti quickly reach a bathroom

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6
Q

What is stress incontinence

A

urine leakage due to abrupt increases in intra-abdominal pressure (cough / jumping)

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7
Q

What are the typical causes of stress incontinence

A

Childbirth, pelvic floor laxity, atrophic urethritis, radical prostatectomy

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8
Q

What are the typical causes of stress incontinence

A
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9
Q

Which patients will experience more severe symptoms with stress incontinence

A

obese patients because of the excess abdominal pressure

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10
Q

What is overflow incontinence

A

dribbling of urine from an overly full bladder

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11
Q

What is the 2nd most common type of incontinence in men

A

overflow incontinence

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12
Q

What is functional incontinence

A

Urine loss due to cognitive or physical impairments or environmental factors that interfere with voiding control

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13
Q

What is mixed incontinence

A

Any combination of types

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14
Q

What is mixed incontinence

A

Any combination of types

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15
Q

What causes bladder incompetence

A

with aging, bladder capacity decrease and the ability to inhibit urination declines, bladder contractility is impaired

post void residual volumes increase

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16
Q

What is the cause of bladder incompetence in men

A

prostate size increases, partially obstructing urethra, leading to incomplete bladder emptying and strain on detrusor muscle

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17
Q

What generally causes bladder incompetence in younger patients

A

often begins suddenly, may cause some leakage and usually resolves quickly with little to no treatment

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18
Q

What are some causes of transient incontinence

A

delerium
infection (symptomatic UTI)
atrophic urethritis/vaginitis
pharmeceuticals
psych disorders
excess urine output
restricted mobility
stool impaction

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19
Q

What is the reason for established incontinence

A

persistant problem affecting nerves or muscles

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20
Q

What are the mechanisms that may cause urinary incontinence

A

bladder outlet obstruction
detrusor over/under activity
detrusor sphincter dyssynergia
combination

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21
Q

What is outlet incompetence

A

common cause of stress incontinence

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22
Q

What is the main cause of outlet incompetence in women

A

pelvic floor weakness from vaginal deliveries or pelvic floor surgery

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23
Q

What is the main cause of outlet incompetence in men

A

common cause is damage to sphincter or to bladder neck and posterior urethra after radical prostatectomy

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24
Q

Why does an obstruction cause urinary incontinence

A

it causes an over distended bladder and the loss of ability to contract which leaves the bladder with a high residual volume and then causing overfill

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25
Q

What is the common cause of urge incontinence in older and younger patients

A

detrusor overactivity

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26
Q

What is overactive bladder

A

Describes urinary urgency, often accompanied by urinary frequency and nocturia

27
Q

What is the cause of detrusor under activity in men

A

fibrosis and connective tissue replace the detrusor leading to chronic outlet obstruction

28
Q

What is detrusor-sphincter Dyssynergia

A

Loss of coordination between bladder contraction and external urinary sphincter relaxation

29
Q

What is the most common cause of detrusor sphincter dyssynergia

A

Due to spinal cord lesions that interrupts pathways to pontine micturition center

*causes Christmas tree deformations of the bladder

30
Q

Who should be screened for incontinence

A

all adults

31
Q

What will atrophic vaginitis and urethritis look on exam

A

pale, thin vaginal mucosa with loss of rugae

32
Q

How will you test for uretheral hyper mobility

A

Cough with the posterior vaginal wall stabilized with a speculum

33
Q

How do you preform a urinary stress test

A

A patient with a full bladder, sit up on an exam table with their legs spread and relaxes the perineal are and coughs vigorously once

34
Q

What confirms an incontinence diagnosis

A

Immediate leakage that starts and stops with cough on the urinary stress test

35
Q

What does delayed or persistent leakage indicate with a urinary stress test

A

detrusor overactivity

36
Q

What is the Marshall-Bonney test

A

Repeat the urinary stress test, except with 1-2 fingers inside the vagina to elevate urethra

37
Q

What is the purpose of the Marshall-Bonney test

A

to see if the patient may respond to surgery

38
Q

What tests can be preformed when working up urinary incontinence

A

urinalysis / urine culture
BUN/Creatinine
postvoid residual volume
urodynamic testing

39
Q

When is urodynamic testing done

A

when clinical eval and appropriate tests are not diagnostic or when abnormalities must be precisely characterized before surgery

40
Q

What is the purpose of measuring post void residual volume

A

PVR + voided volume estimates the total bladder capacity and assess bladder proprioception

41
Q

What is normal PVR

A

<50

42
Q

What is PVR suggests detrusor under activity or outlet obstruction

A

> 200mL

43
Q

What is urodynamics

A

term for all encompassing series of tests and procedures regarding the lower urinary tract

44
Q

What is a cystometrogram

A

testing bladder function, pressure, and volume

45
Q

What is electromyography

A

recording of electrical activity within muscle tissue

46
Q

What is the urethral pressure profile

A

measuring the balance of pressure along the urethra

47
Q

What is uroflowmetry

A

Testing the volume of urine released from the body

48
Q

What are some general treatment measures for incontinence

A

Limit fluid intake at certain times
avoid fluids that irritate bladder
portable commode
check drugs that could aggravate

49
Q

What are some ways to bladder train

A

Timed voiding
*urinate every 2-3 hours while awake

Prompted voiding
*for cognitively impaired patients

Using a voiding diary to track all voids

50
Q

Which for of incontinence are Kegel exercises most useful for

A

stress incontinence

51
Q

What are Kegel exercises

A

Contract the pelvic floor muscles rather than the thigh, abd, and buttock muscles.

*contract 10 seconds, relax 10 seconds, 10-15xs TID

52
Q

What are automative Kegel exercises

A

pelvic floor electrical stimulation

53
Q

What is the purpose of relaxation techniques for urinary incontinence

A

improve emotional and physical responses to the urge to void

54
Q

What are the most common drugs to help with urge incontinence if not managed with behavioral therapy

A

Oxybutynin and tolterodine
*anticholinergic and antimuscarinic

55
Q

what is onabotulinum and when is it used

A

administered via cystoscopic injection into detrusor muscle

useful for surge incontinence refractory to other treatment in patients with neurologic causes

56
Q

What are some procedures for urge incontinence

A

Sacral nerve stimulation
posterior tibial nerve stim
surgery

57
Q

What is sacral nerve stimulation

A

implantedd neurostimulator

58
Q

What is posterior tibial nerve stimulation

A

Application of low voltage stimulation for 30 min sessions for 10-12 weeks

59
Q

How do you treat stress incontinence

A

bladder training
kegel exercises
avoiding stressors that provoke
losing weight if obeses
exercise with vaginal cones

60
Q

What are some drugs for stress incontinence

A

pseudoephedrine
imipramine / duloxetine
topic estrogen

61
Q

When is topical estrogen indicated

A

atrophic urethritis

62
Q

What is pseudoephedrine indicated

A

women with outlet incontinence

63
Q

When is imipramine and duloxetine indicated

A

mixed stress and urge incontinence or stress alone

64
Q

How can you treat overflow incontinence

A

bladder decompression with intermittent self catheterization

Women's Health Clin med (13 decks)

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