Urinary Incontinence Flashcards
causes of male incontinence
usually BPH or neurologic dz; uro eval indicated in incontinent male pts
General characteristics urinary incontinence
Five major types of incontinence:
- urge
- stress
- overflow
- reflex
- functional
many pts have >1 type
causes of female incontinence
usually due to hormonal changes, pelvic floor dysfunction or laxity, or uninhibited bladder contractions (detrusor contractions) due to aging
Most common cause of incontinence in elderly…
urge incontinence!
most common cause of incontinence in women < 70
stress incontinence!
Risk factors incontinence
- age (diminished size of bladder, earlier detrusor contractions, postmenopausal genitourinary atrophy)
- recurrent uti
- immobility, decreased mental status, dementia, stroke, Parkinson’s dz . depression
- DM, CHF
- multiparity, hx of prlonged labor
- pelvic floor dysfunction in women, bph and prostate cancer in men
- meds
- diuretics increase bladder filling, increased episodes of incontinence
- anticholinergics and adrenergics cause urinary retention
- beta blockers diminish sphincter tone
- calcium channel blockers and narcotics can decrease detrusor contraction
- alcohol, sedatives, hypnotics (depress mentation)
Evaluating pt w urinary incontinence
- inquire about hx of diabetes, MS, parkinsons, stroke, spinal cord injury or dz, and pelvic sx
If urgency of urination is prominent finding…
suspect urge incontinence
If increased intra abdominal pressure (cough, laugh) causes urine loss…
suspect stress incontinence
Elderly women commonly have ____ and ____ incontinence
urge and stress
Urge incontinence aka detrusor instability
- most common type in elderly and nursing home pts
- multiple causes (often idiopathic): dementia, strokes, severe illness, parkinsons dz
- mxn: involuntary and uninhibited detrusor contractions –> involuntary loss of urine
- clinical features: sudden urge to urinate (pts unable to make it to bathroom), loss of large volumes of urine w small postvoid residual, nocturnal wetting
- dx study: urodynamic study
- mgmt: initially bladder training exercises (goal: increase amt of time bw voiding)
if unsuccessful: meds (including anticholinergic meds like oxybutynin and TCAs like imipramine)
Stress incontinence
- occurs mostly in women (after multiple deliveries of kids)
- mxn: weakness of pelvic diaphragm (pelvic floor) –> loss of bladder support –> hypermobility of bladder neck –> proximal urethra descends belwo pelvic floor so an increase in intraabdominal pressure transmitted mostly to bladder instead of equal transmission to bladder and urethra
clincal features: involuntary urine loss (only in spurts) during activities that increase intra abdominal pressure (cough, laugh, sneeze, exercise); small postvoid volume
rule out infection with urinalysis
mgmt: kegel exercises (contract pelvic floor muscles) to strengthen pelvic floor muscles; estorgen replacement therapy , use of pessary; sx (urethropexy to elevate vesicourethral junction and return hypermobile bladder neck to original position)
Overflow incontinence
- common in diabetic pts and pts w neurologic disorders
- mxn: inadequate bladder contraction (impaired detrusor contractility) or bladder outlet obstruction –> urinary retention and subsequent overdistension of bladder
bladder pressure increases until it exceeds urethral resistance –> urine leakage
causes: neurogenic bladder (diabetic pts, lower motor neuron lesions), obstruction to urine flow (BPH, prostate cancer, urethral strictures, severe constipation w fecal impaction), meds (anticholinergics, alpha agonists, epidural/spinal anesthetics)
- clinical features: nocturnal wetting, frequent loss of small amt of urine, large postvoid residual (>100mL)
- mgmt: primarily medical; intermittent self cathetirization is best; cholinergic agents (bethanecol) to increase bladder contractions; alpha blockers (terazosin, doxazosin) to decrease sphincter resistance
Reflex incontinence
spinal cord injury most common cause
other: MS, diabetes, tabes dorsalis, disc herniation, spinal cord compression 2/2 tumor
pts cant sense need to urinate!!!!
functional incontinence
2/2 disabling and debilitating dzs
