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Gen Med Unit 5 > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

Define urinary incontinence

A

Involuntary loss of urine

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2
Q

What demographic is most likely to experience incontinence?

A

Affects females 2:1 over males
Most common among elderly
30% elderly women
15% elderly men

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3
Q

What is the average volume of urine a bladder can hold?

A

350- 550 ml

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4
Q

At what volume does the urge to urinate begin at?

A

200 ml

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5
Q

What are the types of urinary incontinence?

A 
Urge 
Stress
Mixed 
Overflow
Neurogenic
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6
Q

define urge incontinence

A

Uncontrolled urine leakage occurs immediately after an urgent, irrepressible need to void

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7
Q

Pathophys of urge incontinence

A
  1. Detruser muscle overactivity (OAB)
  2. Atrophic urethritis
  3. Idiopathic
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8
Q

What demographic group is urge incontinence most prevalent in?

A
  1. Most common type in elderly
  2. Increases w/ aging
  3. Childhood enuresis
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9
Q

Define stress incontinence

A

Leakage due to abrupt increases in intra-abdominal pressure:
cough, sneeze, laugh, bend, lift

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10
Q

What demogrpahic is stress incontinence most prevalent in?

A

Most common in young to middle aged females

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11
Q

Stress incontinence pathophys

A
  1. Urethral sphincter incompetence due to

Childbirth, atrophic urethritis, spinal injury, prostate procedure, obesity

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12
Q

Define overflow incontinence

A
  1. Continuous leakage or dribbling
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13
Q

What is the least common form of incontinence?

A

Overflow incontinence

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14
Q

What demographic is overflow incontinence most prevalent in?

A
  1. Rare in women

2. Seen in men with BPH, stricture, or prostate cancer

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15
Q

Pathophys of overflow incontinence

A
  1. incomplete bladder emptying
  2. Impaired detrusor muscle contractility (underactive)
  3. Urinary retention leads to bladder distention & overflow of urine
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16
Q

Define functional incontinence

A

Urine loss due to cognitive or physical impairments

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17
Q

What are risk factors for functional incontinence?

A
  1. Stroke
  2. Dementia
  3. PD
  4. MS
  5. Spinal injury
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18
Q

What is the most common type of mixed incontinence?

A

Urge and stress

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19
Q

What demographic is mixed incontinence most prevalent in?

A

Most common in 65+ females

20
Q

Pathophys of incontinence

A
  1. Caused by persistent problem affecting nerves or muscles
    A. Bladder outlet incompetence or obstruction
    B. Detrusor over/under activity
21
Q

What causes outlet incompetence in women?

A 
1. Usually result of weakened pelvic floor muscles 
A. Multiple vaginal deliveries
B. Pelvic surgery
-Hysterectomy 
C. Age related changes 
-Decreased estrogen causes: 
Atrophic vaginitis
Urethritis
Decreased urethral resistance
22
Q

What causes outlet incompetence in men?

A
  1. Damage after radical prostatectomy
    A. Sphincter deficiency
    B. Bladder neck
    C. Posterior urethra
23
Q

What causes outlet obstruction?

A
  1. Urethral stricture
  2. Large bladder diverticula (rare)
  3. Bladder calculi
  4. Cystocele: seen in women, a weakness in the muscle between the bladder and the anterior wall of the vagina
  5. BPH
  6. Prostate cancer
24
Q

What are neurologic causes of detruser overactivity?

A
  1. Alzheimer disease
  2. Spinal cord injury/dysfunction
  3. Multiple sclerosis
  4. Stroke
25
Q

What are non- neurologic causes of detruser overactivity?

A
  1. Bladder carcinoma
  2. Cystitis
  3. Idiopathic
  4. Outlet obstruction or incompetence
26
Q

What are neurologic causes of detruser underactivity?

A
  1. Autonomic neuropathy
    - Diabetes
    - Alcoholism
    - Vitamin B12deficiency
  2. Disk compression
  3. Spine surgery
  4. Tumor
27
Q

What are non-neurologic causes of detruser underactivity?

A
  1. Chronic bladder outlet obstruction

2. Idiopathic (women)

28
Q

What are common Hx symptoms for incontinence?

A
  1. Meds: anticholinergics, decongestants, antihistamines
  2. Drug/ETOH use
  3. Obstetric Hx
  4. Surgical Hx (spine, pelvis)
  5. Voiding diary 48-72hr
    - Record volume, time of void
    - Incontinence in relation to associated activities
    - Eating, drinking, drug use, sleep
    - Amount of leakage
29
Q

What are the relevant systems to examine for incontinence?

A
  1. Cardiac exam
  2. Abdominal exam
  3. Pelvic exam (cystocele, prolapse)
  4. Rectal exam (prostate)
  5. Neurologic
    - Gait, mental status, LE function, reflexes, check for peripheral or autonomic neuropathy (orthostatic hypotension, sphincter tone)
30
Q

What DS tests are indicated in incontinence?

A
  1. UA, urine C&S
  2. As indicated
    A. Glucose if polyuria
    B. Electrolytes if patient confused
    C. BUN/Cr
    D. B12 level if indicated
  3. Possible urodynamics by specialist
  4. Post void residual (< <50 cc normal, 100cc in elderly)
31
Q

What is the tx for incontinence?

A
  1. Treat specific causes
    2, Treat skin to prevent breakdown
  2. Discontinue drugs causing symptoms:
    CCB, morphine, pseudoephedrine, diphenhydramine, haloperidol, risperidone
32
Q

What medications are used for incontinence?

A
  1. (Anticholinergics)
    A. Relax detrusor muscle in OAB
  2. Antimuscarinic agents
  3. Tricyclic Antidepressants
33
Q

What are the contraindications for anticholinergics?

A

Narrow angle glaucoma

34
Q

What are the SE for antimuscarinic meds?

A

S/E dry mouth, delirium, constipation

35
Q

What are the SE for tricyclic antidepressants?

A

Blurred vision, dizziness, dry mouth, fatigue, insomnia, nausea

36
Q

What are some examples of antimuscarinic drugs used for incontinence?

A 
Oxybutynin (Ditropan, Ditropan XL,Oxytrol-OTC)
Darifenacin (Enablex) 
Fesoterodine (Toviaz) 
Mirabegron (Myrbetriq) 
Solifenacin (Vesicare) 
Tolterodine (Detrol, Detrol LA) 
Trospium (Sanctura)
37
Q

What are some examples of TCAs used for incontinence?

A

Imipramine (Tofranil)

38
Q

What specific incontinence types are TCAs used for?

A

Nocturia
Nocturnal enuresis in children
*Alternative-desmopressin (DDAVP) > 6yr

39
Q

What is the treatment of outlet obstruction in men with urge/overflow incontinence?

A 
1. Alpha antagonists
tamsulosin (Flomax)
terazosin (Hytrin)
doxazosin (Cardura)
alfzosin (Uroxatral)
2. 5a-reductase inhibitors
finasteride (Proscar)  
dutasteride (Avodart) 
3. Jalyn (dutasteride/tamsulosin)
40
Q

What alternative (off label) treatments can be used for incontinence?

A
  1. Pseudoephedrine
    A. Alpha agonist effect-urine retention
  2. Duloxetine (Cymbalta)
    A. SNRI-urine retention
41
Q

What are the contraindications for Pseudoephedrine?

A

Avoid if HTN, CAD, narrow-angle glaucoma, thyroid Dz

42
Q

What are the contraindications for Duloxetine (Cymbalta)

A

Caution with glaucoma, renal isufficiency, elderly

43
Q

When is surgery used for incontinence?

A
  1. Last resort
  2. Cystocele repair, bladder suspension, TURP
  3. 96% effective in stress incontinence
44
Q

What devices can be used in incontinence treatment?

A
  1. Self catheterization
  2. Temporary indwelling catheter
  3. Pessary
45
Q

What other tx can be used for incontinence?

A
  1. Suprapubic pressure
  2. Double voiding
  3. Valsalva maneuver for detrusor underactivity
46
Q

What education needs to be given for ppl with incontinence?

A
  1. Bladder training
    A. Void frequently
  2. Limit fluid before going out or 3-4hr before hs
  3. Avoid bladder irritants
    A. Caffeine, carbonation
    B. Drink 48-64oz fluid qd, concentrated urine irritates bladder
  4. Pelvic muscle exercises (Kegel)
    A. Especially effective for stress incontinence
    B. Contract pelvic muscles x 10 sec, relax x 10 sec
  5. Portable commode
  6. Specialized pads/undergarments

Gen Med Unit 5 (8 decks)

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