Urinary Incontinence

Question 1

Urinary incontinence is when

Answer 1

there is an involuntary loss of urine

Question 2

Urinary incontinence presentation

Answer 2

near constant dribbling or intermittent voiding with or without awareness of need to void
extreme urgency with little or no warning; may be unable to hold urine until reaching bathroom
worsens with maneuvers that increase intra-abdominal pressure
pt engages in bathroom mapping

Question 3

Urinary incontinence types:

Answer 3

1. Urge incontinence (m.c in elderly)
2. Stress incontinence (2nd m.c in women d/t childbirth)
3. Overflow incontinence (m.c in men)

Question 4

Urge incontinence is

Answer 4

most common in older people
uncontrolled urine leakage (mod-large volume) immediately after urgent, irrepressible need to void

Question 5

Stress incontinence is:

Answer 5

2nd most common type in women
urine leakage due to abrupt increase in intra-abdominal pressure (coughing, sneezing, laughing, bending, jumping or lifting)
Leakage volume usually low to moderate (depending on fullness)

Question 6

Overflow incontinence is:

Answer 6

2nd most common type in men
dribbling of urine from overly full bladder
volume usually small, but leaks may be constant

Question 7

Functional incontinence is

Answer 7

urine loss due to cognitive or physical impairments or environmental barriers that interfere with control of voiding

Question 8

Mixed incontinence is

Answer 8

any combination of other types

Question 9

Urinary incontinence pathophysiology in older patients:

Answer 9

with aging bladder capacity decreases and ability to inhibit urination declines, detrusor overactivity occurs more often and bladder contractility is impaired

Question 10

Urinary incontinence pathophysiology of postmenopausal women

Answer 10

decreased estrogen leads to atrophic urethritis/ vaginitis, decreased urethral resistance and closure pressure

Question 11

Urinary incontinence pathophysiology in men

Answer 11

prostate size increases partially obstructing urethra leading to incomplete bladder emptying and strain on detrusor muscle, facilitate incontinence but does not cause it

Question 12

Urinary incontinence pathophysiology in younger pts

Answer 12

often begins suddenly, may cause little leakage and usually resolves quickly with little or no treatment, one cause in younger pts but several in older pts

Question 13

Transient urinary incontinence causes:

Answer 13

delirium
infection
atrophic urethritis/vaginitis
pharmaceuticals
psych disorders
excess urine output (DI)
restricted mobility
stool impaction

Question 14

Transient urinary incontinence is

Answer 14

something that comes up quickly and if we address it the issue can usually be resolved - correctable

Question 15

Established Urinary incontinence is

Answer 15

caused by persistent problem affecting nerves or muscles:
bladder outlet incompetence or obstruction
detrusor overactivity or underactive
detrusor-sphincter dyssynergia
combination

Question 16

Established Urinary incontinence is a common cause of

Answer 16

stress incontinence

Question 17

Outlet obstruction leads to

Answer 17

chronically overdistended bladder, loses ability to contract, bladder does not empty resulting in overflow

detrusor overactivity and urge incontinence - detrusor muscle loses its ability to contract

Question 18

Detrusor overactivity is

Answer 18

“overactive bladder” - urgency, frequency, a weak flow rate, urinary retention
often accompanied by urinary frequency and nocturia

Question 19

Detrusor underactivity is

Answer 19

urinary retention and overflow incontinence

Question 20

Detrusor-sphincter dyssynergia is

Answer 20

loss of coordination between bladder contraction and external urinary sphincter relaxation
rather than the sphincter relaxing when bladder contracts, sphincter contracts obstructing bladder outlet

Question 21

What must be excluded before beginning treatment for incontinence

Answer 21

urinary retention

Question 22

Physical exam for urinary incontinence needs to consist of

Answer 22

neurologic, pelvic and rectal exams are focus

Question 23

Urinary incontinence: stress testing is

Answer 23

on exam table with full bladder, patient sits upright with legs spread, relaxes perineal area and coughs vigorously

Question 24

immediate leakage that starts and stops with cough means

Answer 24

confirmed stress urinary incontinence

Question 25

Delayed or persistent leakage suggests detrusor overactivity

Answer 25

detrusor overactivity triggered by cough

Question 26

If cough triggers incontinence in the urinary stress test you should

Answer 26

repeat while examiner places 1-2 fingers inside the vagina to elevate the urethra (marshall-bonney test) incontinence that is corrected by this maneuver may respond to surgery

Question 27

Postvoid residual volume results

Answer 27

< 50 ml is normal
<100 ml is usually acceptable > 65 yo but abnormal in younger
> 200 ml suggests detrusor underactivity or outlet obstruction

Question 28

What is peak urinary flow rate testing used for

Answer 28

to confirm or exclude outlet obstruction in men

Question 29

Electromyography of perineal muscle is used for

Answer 29

assessing the sphincter innervation and function

Question 30

Urinary incontinence treatment:

Answer 30

specific causes are treated, drugs that cause or worsening D/C’d or dosing is altered
general - limit fluid intake at certain times, avoid fluids that irritate the bladder
portable commode, absorbent pads or undergarments
timed voiding or prompted voiding
kegel exercises, relaxation techniques, bladder training

Question 31

Urinary incontinence treatment: Drugs

Answer 31

oxybutynin and tolterodine most common (make sure they do not have retention because this will make it worse)
Onabotulinum toxin A - administered via cystoscopic injection into detrusor muscle

Question 32

Urge incontinence treatment procedures:

Answer 32

sacral nerve stimulation - implanted neurostimulator
posterior tibial nerve stimulation
surgery - last resort, usually younger pts with severe urge incontinence refractory to other treatments

Question 33

stress incontinence behavioral treatment

Answer 33

bladder training
kegel exercises
avoiding physical stresses that provoke incontinence
losing wt
exercise regimens using vaginal cones (retained for 15 min twice a day)

Question 34

stress incontinence drugs

Answer 34

pseudoephedrine
Duloxetine, imipramine
if due to atrophic urethritis - topical estrogen

Question 35

Urinary stress incontinence devices

Answer 35

various mesh slings
pessaries
silicone suction caps over urethral meatus