urinary incontinence

Question 1

stress

Answer 1

urine leakage associated with increased abdominal pressure from laughing, sneezing, coughing, climbing stairs, or other physical stressors on the ab cavity and thus the bladder.

Question 2

urge

Answer 2

involuntary leakage accompanied by or immediately preceded by urgency

Question 3

mixed

Answer 3

combo of stress and urge incontinence, marked by involuntary leakage associated with urgency and also with exertion, effort, sneezing, or coughing.

Question 4

functional

Answer 4

the inability to hold urine due to reasons other than neuro-urologic and lower urinary tract dysfunction

Question 5

diagnosis of incontinence

Answer 5

• severity and quantity of urine lost
• frequency of incontinence episodes
• duration
• triggering factors or events
• constant vs intermittent urine loss
• history of UTIs
• concomitant fecal incontinence or pelvic organ prolapse

Question 6

urodynamic studies for UI

Answer 6

stress testing
cystometry
uroflowmetry
postvoid residual urine volume
abdominal leak point pressure
urethral pressure profile

Question 7

treatment of stress incontinence

Answer 7

surgery, pelvic floor physiotherapy, anti-incontinence devices and medication

Question 8

treatment of urge incontinence

Answer 8

changes in diet, behavioral modification, pelvic floor exercises, and/or medications and new forms of surgical interventions

Question 9

mixed incontinence treatment

Answer 9

anticholinergic drugs and surgery

Question 10

overflow incontinence treatment

Answer 10

catheterization regimen or diversion

Question 11

functional incontinence treatment

Answer 11

treatment of the underlying cause

Question 12

surgical treatment for SUI

Answer 12

increase urethral outlet resistance:

• bladder neck suspension
• periurethral bulking therapy
• midurethral slings
• artificial urinary sphincter

Question 13

pathophys of SUI

Answer 13

major cause: urethral hypermobility due to impaired support from pelvic floor
less common cause: intrinsic sphincter deficiency
urethral sphincter function impaired resulting in urine loss at lower than usual abdominal pressures

Question 14

intrinsic sphincter deficiency

Answer 14

urethral sphincter is unable to coapt (close)

due to devascularization and/or denervation of the bladder neck and proximal urethra

Question 15

pathophys urge incontinence

Answer 15

involuntary urine loss associated with a feeling of urgency.
urodynamic term is detrusor overactivity

Question 16

pathophys of mixed incontinence

Answer 16

UI resulting from a combo of stress and urge incontinence

Question 17

pathophys of overflow incontinence

Answer 17

major contributing factor: incomplete bladder emptying secondary to impaired detrusor contractility or baldder outlet obstruction. impaired detrusor is typically neurogenic in nature

Question 18

stress incontinence treatment

Answer 18

alpha agonists is 19-74%, muscle exercise and surgery 87%

Question 19

urge incontinence treatmen

Answer 19

higher with bladder training
anticholinergics
surgical options are limited and have high mortality

Question 20

mixed incontinence treatment outcomes

Answer 20

bladder training and pelvic exercises result in higher improvement rate than the use of anticholinergic medications

Question 21

overflow incontinence treatment outcomes

Answer 21

medications and surgery are very effective in improving symptoms

Question 22

epidemiology of incontinence

Answer 22

age is single largest risk factor
2 times more common in females
50-84% of elderly persons in long term care facility