Urinary Incontinence Flashcards
Urinary incontinence (UI) is the complaint of _________________
involuntary leakage of urine
There are a number of types of urinary incontinence:
1.
2.
3.
4.
1) Stress 2) Urge 3) Overflow 4) Functional
Impairment in _____ function leads to incontinence
urethral
Under normal conditions urethral pressure ______ bladder pressure resulting in urine remaining in the bladder
exceeds
Some symptoms of urinary incontinence include:
1.
2.
3.
- Voiding (small or large volumes)
- Nocturia
- Dribbling
unable to hold voiding, urine loss with abdominal pressure, dyspareunia (painful intercourse), dysuria
Non-modifable risk factors for urinary incontinence:
1.
2.
Female gender, Elderly,
Modifiable risk factors:
1.
2.
3.
4.
- Caffeine intake
- BPH in men
- Obesity
- Medications
Smoking, Bowel problems, fluid intake, limited physical activity, lower urinary tract conditions, restricted mobility
What is the most common form of UI in women?
Stress incontinence
Urine leakage in stress incontinence is the result of __________ causing pressure inside the bladder to overcome the ability of the compromised urethral sphincter to close the urethra
increased intra-abdominal pressure (cough, sneeze, laugh)
__________ involves leakage of moderate to large amounts of urine due to inability to delay voiding when an urge is perceived
Urge incontinence
__________ is a syndrome that includes urgency and can lead to urge incontinence
Overactive bladder
Chronic retention of urine often involves leakage of urine which leads to __________ incontinence when the amount of urine retained produces pressure beyond the sphincter or obstruction pressure.
Overflow incontinence presents with ________ (the type of frequency)
dribbling
_______________ is the loss of urine caused by the inability to get to or use the toilet, and does not involve changes in the lower urinary tract
Functional incontinence
Causes of functional incontinence
1.
2.
3.
physical constraints (ex restricted mobility) cognitive factors (dementia, depression) and environmental barriers (access to toilet, positioning)
Examples of drug related causes
1.
2.
3.
4.
5.
- Antihistamines
- Anticholinergics
- Sedatives
- Narcotics
- Cholinergics
Muscle relaxants, caffeine, ethanol, etc
First line management involves _______ and ________
behavioural therapy lifestyle changes
Third line treatment:
Botox
First line treatment for stress incontinence
- pelvic muscle exercises
biofeedback, exercise/weight loss if overweight, pessaries, surgical intervention
The following medications have low evidence for treatment in stress incontinence
vaginal estrogen & duloxetine
First line treatment for urge incontinence
Behavioural therapy
Bladder retraining
Scheduled toileting
Pelvic muscle exercise
_____________ are considered second-line treatment for urge incontinence when nonpharmacologic options fail to provide adequate symptomatic relief
antimuscarinics and beta3 agonist mirabegron
Treatment for overflow due to obstruction
alpha antagonists or surgery
Treatment for overflow due to detrusor under activity
catheterization, diapers and reassessing medication causes
Treatment of urinary incontinence during pregnancy involves ______________
pelvic floor rehabilitation
Common side effects of the anticholinergic medications (Oxybutinin, Tolterodine, Darfenacin, Solfenacin, Trospium, Fesoterodine)
Blurred Vision
Delirium
Constipation (++ common)
Sedation (++ common)
Urinary retention
Dry mouth
Anticholinergics should be avoided in patients with
1.
2.
3.
- Urinary/gastric retention
- narrow-angle glaucoma
- cardiac patients
These two anticholinergics DO NOT cross the BBB and may be better tolerated in the elderly
1.
2.
- Tolterodine
- Trospium
The most common adverse effects of mirabegron include:
1.
2.
3.
Hypertension
Nasopharyngitis
Urinary tract infections
Headaches
Avoid ________ in sever, uncontrolled hypertension
Mirabegron (also dont crush/chew)
TCA’s may be used in patients with concomitant ____ or ____
depression or neuropathy
If TCA are required in elderly, consider _____ and _____ due to lower risk of anticholinergic s/e
notriptyline and desipramine
most common type of incontinence in men?
overflow
The following anticholinergic is not metabolized by the CYP450 system
Torspium
