Urinary Incontinence Flashcards
Urge Urinary Incontinence
Overactive bladder (OAB) - detrusor contracts during filling phase
Stress Urinary Incontience
Urethra or urethral sphincters cannot sufficiently impede urine flow
Overflow incontinence
Bladder underactivity
Bladder outlet obstruction
Symptoms of UUI
> 8 times/day and urgency
Nocturia (>1/night) and/or enuresis (incontinence at night)
Volume large due to complete emptying of the bladder
Symptoms of SUI
During activities that increase intraabdominal pressure (running, coughing, sneezing)
Small volume, proportional to level of activity
Overflow Incontinence
Bladder is filled to capacity but unable to empty
Loss of function of detruser muscle
Obstruction
Overflow incontience symptoms
Difficulty initiating stream
Dribbling
Small amounts of urine leaking constantly
Non-pharm management
Weight loss
Bladder training for UUI
Pelvic flow muscle rehab
Anti-incontinence device
UUI Recommendations
Bladder training
Weight loss
Drugs
SUI Recommendations
Pelvic floor muscle training
Weight loss
Topical meds
UUI + Antichollinergic agent/antispamodics MOA
Antagonize muscarinic receptors
Decrease PS nerve impulses to detrusor
- Most effect for suppression of premature detrusor contraction, enhancing bladder storage and reliving symptoms
First line UUI treatment
oxybutynin or tolterodine
Oxybutynin IR
Ditropan
***Orthostatic hypoTN
Oxybutynin ER =
Ditropan XL
***Orthostatic hypoTN
Tolterodine
Detrol (LA)
Dry mouth, headache, constipation
Fesoterodine
Toviaz
Dry mouth, constipation
Solifenacin and Darifenacin
Vesicare and enablex
Dry mouth, constipation
Trospium
Sanctura (XR)
Dry mouth, constipation, headache
Esp in elderly
Beta 3 Agonist
UUI
Mirabegron (myrbetriq)
Mirabegron
Myrbetriq
High BP, tachycardia
Alternative for those who can’t handle anticholinergic effects
Tricylic antidepressants + UUI
Only if they have depression
**Orthostatic hypoTN
Desipramine and nortriptyline
SUI first line treatment =
Duloxetine (cymbalta)
Duloxetine
Cymbalta
Nausea, headache, insomnia
Alpha adrenergic agonists
SUI
Pseudoephedrine
Phenylephrine
HTN, headache, insomnia
Topical estrogeins
SUI + urethritis or vaginitis
Overflow Incontinence Treatment if Bladder underactivity
Self-cathertization 3-4 X day
Bethanechol
Overflow Incontinence Treatment if BOO
Relief of the obstruction