urinary incontinence

Question 1

continence equation

Answer 1

pressure in bladder < pressure seal of urethra + Lift/pressure of levator ani (gate) = Continence

Question 2

factors contributing to Urinary Incontinence

Answer 2

(1) fluid intake - (less-irritation to bladder causes UI & more- overload bladder)
* **avoid caffeinated , alcoholic, tea, carbonated beverage, artificial sweeteners

(2) cosntipation
(3) habitual preventive emptying
(4) familial
(5) age
(6) pregnancy & childbirth
(7) BMI
(8) comorbidities : smoking medications & specific health conditions (dm, stroke, htn)

Question 3

stress urinary incontinence

Answer 3

Involuntary leakage with effort or exertion, SNEEZING or COUGHING
**hypermobility of bladder neck or insufficient urethral closure pressure

Question 4

urge urinary incontinence

Answer 4

Strong desire to urinate that is DIFFICULTY TO POSTPONE
involuntary leakage accompanied by or immediately preceded by URGENCY
uninhibited contractions of the detrusor muscle, frequency

Question 5

mixed urinary incontinence

Answer 5

involuntary urine leakage associated with symptoms of both stress and urge urinary incontinence

Question 6

continuous urinary incontinence

Answer 6

extremely low urethral closure pressure

Question 7

knack maneuver

Answer 7

pelvic muscle contraction (incoporating the levator ani and urethral striated muscle) that is stragegically timed to increase intraurethral pressure just before and during an event that cause leakage.

Question 8

pelvic floor exercise –Kegel exercise

Answer 8

repetitive contraction of pelvic floor muscle. the goal is to increase muscle mass and strength. offer rehabilitation for women whose muscles have been weakened.

Question 9

pharmacological treatment for URGE incontinence

Answer 9

anticholinergic/antimuscarinic agents–> oxybutynin (DITROPAN), tolterodine (DETROL)
**target parasympathetic muscarinic cholinergic receptor sites of smooth muscle in the bladder–reduce involuntary contractions of the detrusor muscle of the urinary bladder and increases the bladder capacity.

Question 10

pharmacological treatment for STRESS incontinence

Answer 10

no approved drug
off label –> alpha-adrenergic agonists act on the alpha-receptor sites in the bladder neck and proximal urethra–>ephedrine & pseudoephedrine (SUDAFED)
duloxetine is a dual serotonin & norepinephrine reuptake inhibitor also use for stress ui

Question 11

surgical for urinary incontinence

Answer 11

(1) implanted sacral nerve stimulator –> urge only
(2) injection of bulking agents –> stress (cough/sneezing)
**Bovine collagen
**Carbon-coated zirconium beads
suspended in water-based carrier gel
(3) tension-free vaginal tape sling procedure -support & stabilize the urethra -stress ui