Urinary incontinence Flashcards
What is urinary incontinence
near constant dribbling / intermittent voiding with / without awareness of the need to void
extreme urgency w little to no warning
What is the most common type of urinary incontinence in elderly
urge incontinence
What are the different types of urinary incontinence
Urge incontinence
stress incontinence
overflow incontinence
functional incontinence
Mixed incontinence
What is urge incontinence
Uncontrolled urine leakage immediately after urgent, irrepressible need to void
What exacerbates urge incontinence
use of diuretics and the inability ti quickly reach a bathroom
What is stress incontinence
urine leakage due to abrupt increases in intra-abdominal pressure (cough / jumping)
What are the typical causes of stress incontinence
Childbirth, pelvic floor laxity, atrophic urethritis, radical prostatectomy
What are the typical causes of stress incontinence
Which patients will experience more severe symptoms with stress incontinence
obese patients because of the excess abdominal pressure
What is overflow incontinence
dribbling of urine from an overly full bladder
What is the 2nd most common type of incontinence in men
overflow incontinence
What is functional incontinence
Urine loss due to cognitive or physical impairments or environmental factors that interfere with voiding control
What is mixed incontinence
Any combination of types
What is mixed incontinence
Any combination of types
What causes bladder incompetence
with aging, bladder capacity decrease and the ability to inhibit urination declines, bladder contractility is impaired
post void residual volumes increase
What is the cause of bladder incompetence in men
prostate size increases, partially obstructing urethra, leading to incomplete bladder emptying and strain on detrusor muscle
What generally causes bladder incompetence in younger patients
often begins suddenly, may cause some leakage and usually resolves quickly with little to no treatment
What are some causes of transient incontinence
delerium
infection (symptomatic UTI)
atrophic urethritis/vaginitis
pharmeceuticals
psych disorders
excess urine output
restricted mobility
stool impaction
What is the reason for established incontinence
persistant problem affecting nerves or muscles
What are the mechanisms that may cause urinary incontinence
bladder outlet obstruction
detrusor over/under activity
detrusor sphincter dyssynergia
combination
What is outlet incompetence
common cause of stress incontinence
What is the main cause of outlet incompetence in women
pelvic floor weakness from vaginal deliveries or pelvic floor surgery
What is the main cause of outlet incompetence in men
common cause is damage to sphincter or to bladder neck and posterior urethra after radical prostatectomy
Why does an obstruction cause urinary incontinence
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
What is the common cause of urge incontinence in older and younger patients
detrusor overactivity
What is overactive bladder
Describes urinary urgency, often accompanied by urinary frequency and nocturia
What is the cause of detrusor under activity in men
fibrosis and connective tissue replace the detrusor leading to chronic outlet obstruction
What is detrusor-sphincter Dyssynergia
Loss of coordination between bladder contraction and external urinary sphincter relaxation
What is the most common cause of detrusor sphincter dyssynergia
Due to spinal cord lesions that interrupts pathways to pontine micturition center
*causes Christmas tree deformations of the bladder
Who should be screened for incontinence
all adults
What will atrophic vaginitis and urethritis look on exam
pale, thin vaginal mucosa with loss of rugae
How will you test for uretheral hyper mobility
Cough with the posterior vaginal wall stabilized with a speculum
How do you preform a urinary stress test
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
What confirms an incontinence diagnosis
Immediate leakage that starts and stops with cough on the urinary stress test
What does delayed or persistent leakage indicate with a urinary stress test
detrusor overactivity
What is the Marshall-Bonney test
Repeat the urinary stress test, except with 1-2 fingers inside the vagina to elevate urethra
What is the purpose of the Marshall-Bonney test
to see if the patient may respond to surgery
What tests can be preformed when working up urinary incontinence
urinalysis / urine culture
BUN/Creatinine
postvoid residual volume
urodynamic testing
When is urodynamic testing done
when clinical eval and appropriate tests are not diagnostic or when abnormalities must be precisely characterized before surgery
What is the purpose of measuring post void residual volume
PVR + voided volume estimates the total bladder capacity and assess bladder proprioception
What is normal PVR
<50
What is PVR suggests detrusor under activity or outlet obstruction
> 200mL
What is urodynamics
term for all encompassing series of tests and procedures regarding the lower urinary tract
What is a cystometrogram
testing bladder function, pressure, and volume
What is electromyography
recording of electrical activity within muscle tissue
What is the urethral pressure profile
measuring the balance of pressure along the urethra
What is uroflowmetry
Testing the volume of urine released from the body
What are some general treatment measures for incontinence
Limit fluid intake at certain times
avoid fluids that irritate bladder
portable commode
check drugs that could aggravate
What are some ways to bladder train
Timed voiding
*urinate every 2-3 hours while awake
Prompted voiding
*for cognitively impaired patients
Using a voiding diary to track all voids
Which for of incontinence are Kegel exercises most useful for
stress incontinence
What are Kegel exercises
Contract the pelvic floor muscles rather than the thigh, abd, and buttock muscles.
*contract 10 seconds, relax 10 seconds, 10-15xs TID
What are automative Kegel exercises
pelvic floor electrical stimulation
What is the purpose of relaxation techniques for urinary incontinence
improve emotional and physical responses to the urge to void
What are the most common drugs to help with urge incontinence if not managed with behavioral therapy
Oxybutynin and tolterodine
*anticholinergic and antimuscarinic
what is onabotulinum and when is it used
administered via cystoscopic injection into detrusor muscle
useful for surge incontinence refractory to other treatment in patients with neurologic causes
What are some procedures for urge incontinence
Sacral nerve stimulation
posterior tibial nerve stim
surgery
What is sacral nerve stimulation
implantedd neurostimulator
What is posterior tibial nerve stimulation
Application of low voltage stimulation for 30 min sessions for 10-12 weeks
How do you treat stress incontinence
bladder training
kegel exercises
avoiding stressors that provoke
losing weight if obeses
exercise with vaginal cones
What are some drugs for stress incontinence
pseudoephedrine
imipramine / duloxetine
topic estrogen
When is topical estrogen indicated
atrophic urethritis
What is pseudoephedrine indicated
women with outlet incontinence
When is imipramine and duloxetine indicated
mixed stress and urge incontinence or stress alone
How can you treat overflow incontinence
bladder decompression with intermittent self catheterization
