Urinary Incontinence Flashcards
What patient population is urinary incontinence the most prevalent in?
Women
Muscle that surrounds the bladder where contraction empties the bladder?
Detrusor muscle
Where is urine stored?
In the bladder
What muscle is at the base of the bladder?
Internal sphincter
What muscle is under involuntary control?
Internal sphincter
What muscle surrounds the urethra?
External sphincter
What muscle is controlled under voluntary control?
External sphincter
The process of emptying the bladder
Micturition
What mL of urine causes the detrusor muscle to contract?
200 mL
What mL of urine cause the detrusor muscle to force open the internal sphincter?
500 mL
What are the 6 risk factors of urinary incontinence?
- Gender (females»males)
- Age >40 yrs
- Smoking
- Family history
- Overweight
- Neurological disorders
What is the acronym for the transient causes of UI?
DIAPPERS
What does the acronym DIAPPERS stand for?
D- delirium
I- infection (UTI)
A- atrophic urethritis/vaginitis
P- pharmaceuticals
P- psychological (depression)
E- excessive urine output (HF or hyperglycemia)
R- restricted mobility
S- stool impaction
What are 9 drug classes that may cause UI?
- Diuretics
- Psychotropics
- Narcotics
- Alpha blockers
- CCBs
- Anticholinergic agents
- Alpha agonists
- Beta agonists
- Ethanol
What are the 5 types of UI?
- Urge
- Stress
- Overflow
- Functional
- Mixed
What is the most common type of UI?
Urge Incontinence
What are 4 risk factors or urge incontinence?
- Increased age
- Neurologic disease
- Diabetes
- Smoking
What are 4 clinical presentations of urge incontinence?
- Urgency
- Frequency (>8 voids/day)
- Nocturia (1> void/day)
- Enuresis (bed-wetting)
When urine leaks out of the bladder during any form of exertion as a result of pressure on the bladder
Stress incontinence
What are 8 risk factors for stress incontinence?
- Pregnancy
- Childbirth
- Menopause
- Atrophic vaginitis
- Cognitive impairment
- Obesity
- Increased age
- Lower UT surgery/injury (men)
When incontinence isn’t seen while sleeping?
Stress incontinence
Involuntary release of urine when the bladder becomes very full, even though the person feels no urges to urinate?
Overflow incontinence
What are 5 common causes of overflow incontinence?
- Bladder outlet obstruction
- Diabetic neuropathy
- Spinal cord injuries
- MS
- Pelvic surgeries
What type of incontinence does not usually occur when sleeping?
Stress incontinence
What are 5 clinical signs and symptoms for overflow incontinence?
- Lower abdominal fullness
- Hesitancy, straining, and decreased force of stream
- Incomplete bladder emptying
- Frequency/urgency
- Increased PVR
What type of incontinence: The inability of a normally continent person to reach the toilet in time to avoid accidents
Functional incontinence
What are 2 most common causes of functional incontinence?
- Musculoskeletal limitations
- Cognitive impairment
What are clinical signs and symptoms of functional incontinence?
Accidents on the way to the toilet and early morning incontinence
What two types of incontinence are involved in mixed incontinence?
Stress and Urge
What is considered first line to treat UI?
Non pharmacologic therapies
What 4 foods should you avoid for UI?
- Aspartame
- Spicy/citrus foods
- Caffeine
- Carbonated beverages
True or false: drug treatment alone has minor benefit, especially in nursing homes
True
When do the best results occur when using medication?
When used on combination with behavioral interventions
What is the best treatment for functional incontinence?
Removing the underlying cause
What is the first line treatment for stress incontinence?
Pelvic floor exercises
What are 5 pharmacologic treatments for stress incontinence?
- Intravaginal estrogens
- Adrenergic agonist
- Duloxetine
- Vaginal pessary and urethral insert
- Surgery to improve stability of the bladder neck
What are the two Intravaginal estrogens that can be used?
- Conjugated estrogens vaginal cream
- Estradiol vaginal ring
What are 3 adverse effects of the Intravaginal estrogens?
- Vaginal spotting
- Breast tenderness
- Nausea
What are 2 adrenergic agonists that can be used in UI?
- Pseudoephedrine
- Phenylephrine
What are 4 ADRs of the adrenergic agonists?
- Dizziness
- Increased blood pressure
- Insomnia
- Headache
What is the purpose of surgery for stress incontinence?
To improve the closure of the sphincter to support the bladder neck
What are 4 treatment options for overflow incontinence?
- Discontinue precipitating medications
- Treat BPH
- Cholinergic stimulation of the detrusor muscle
- Catheterization
What is the MOA of Bethanechol?
Stimulates parasympathetic nervous system, which increases bladder muscle tone, causing contractions to initiate urination
What are 4 ADRs of bethanechol?
- Diarrhea and N/V
- Flushing
- Abdominal cramping
- Salivation
What does catheterization have an increased risk of?
UTIs
What is the first line treatment for urge incontinence?
Antimuscarinics
What receptor is responsible for normal micturition contractions?
M3
How much do antimuscarinics reduce incontinence episodes by? Frequency?
- 50%
- 20%
OXYBUTYNIN
DITROPAN XL; GELNIQUE; OXYTROL
TOLTERODINE
DETROL LA
Fesoterodine
TOVIAZ
SOLIFENACIN
VESICARE
DARIFENACIN
ENABLEX
When should you avoid the use of antimuscarinics?
In older adults with delirium, dementia, cognitive impairment, or chronic constipation
What brand of oxybutynin is highly potent and has high side effects?
DITROPAN
What brand of oxybutynin is better tolerated?
Ditropan XL
What should you avoid when using gelnique?
Bathing for 1 hour after application
How often is the oxytrol patch replaced?
Every 3 to 4 days
When should you change the oxytrol patch?
On the same 2 days each week
What is important to know with oxytrol?
May not see effects until a few weeks of therapy
True or false: Tolterodine is better tolerated than oxybutynin and is more effective
False (less effective)
When should you adjust the dose with DETROL?
When the CrCl is 10-30 mL/min
What is the prodrug of Tolterodine?
Fesoteradine
What dose is used for toviaz?
4 mg QD
What antimuscarinic agent has less cognitive impairment?
Trospium chloride
What 2 animuscarinics are M3 selective receptor antagonists?
- SOLIFENACIN
- Darifenacin
What are the 2 beta-3 adrenergic agonists?
- Mirabegron
- Vibegron
What is the MOA for myrbetriq?
Relaxes the detrusor muscle during the storage phase to increase bladder capacity
What does Myrbetriq have a drug interaction with?
Digoxin
What does Vibegron not interact with but myrbetriq does?
CPY2D6 enzyme
What drug has the worst anticholinergic side effect?
Oxybutynin
MIRABEGRON
MYRBETRIQ
VIBEGRON
GEMTESA
What 3 antimuscarinics are better to use in terms of cognition?
- Solifenacin
- Darifenacin
- Trospium chloride
When can Botox be used?
As a last line agent
How long can an implantable device last?
15 years
