Urinary Incontinence Flashcards
What are the types of urinary incontinence?
Stress incontinence - involuntary urine loss with effort or physical exertion, or sneezing and coughing
Urgency incontinence - involuntary urine loss with urgency, associated with detrusor overactivity
Mixed incontinence
Overflow incontinence - detrusor underactivity, acontractile bladder, bladder outlet obstruction
Bypass incontinence - result of fistula from urinary tract to vagina
Functional incontinence - inability to reach toilet in time (typically seen with limited mobility and dementia)
What are the risk factors for stress incontinence?
Younger/middle-aged women obesity diabetes vaginal delivery genetics pelvic surgery smoking chronic cough meds
What is responsible for urinary continence?
Intraurethral pressure > intravesical pressure
Internal sphincter and external sphincter
submucosal vasculature of the urethra (when filled with blood)
sympathetic nervous system through hypogastric nerve off T10-L2 (parasympathetic from S2-S4 allows micturition)
How is urgency incontinence treated?
Anticholinergic drugs (with antimuscarinic effects) which increase bladder capacity and decrease urgency Oxybutynin Tolterodine Fesoterodine Trospium
What is the goal of surgery for stress incontinence?
Neck slings - resuspend the hypermobile urethra
Tension-free midurethral sling - reinforce the midurethra
Bulking agents for intrinsic sphincter deficiency to improve sphincter tone
What are some causes of urge incontience (detrusor overactivity)?
IDIOPATHIC
infections, tumors, bladder stones, cancer, foreign bodies, urethral diverticuli
neurological damage
Anticholinergic drugs are contraindicated when?
Gastric retention and angle closure glaucoma
dementia
What are the surgical treatments for urge incontinence?
Sacral neuromodulation
Posterior tibial nerve stimulation
Botulinum toxin injection
augmentation cystoplasty
What is treatment for overflow incontinence?
Relieving urinary retention
terazosin, diazepam/dantrolene (muscle relaxants)
cholinergic drugs increase bladder contractility
self-catheterization
surgical correction of obstruction
How does bypass incontinence present?
Continuous, painless urinary dribbling with history of surgery, diverticula, prolapse, birth trauma, PID, pelvic radiation
How is bypass incontinence diagnosed?
Methylene blue or indigo carmine injected into bladder
Treatment of bypass incontinence?
Surgery for fistulas
need to wait 3-6 months if it is post-surgical fistula to reduce inflammation
Antibiotics for UTI and estrogen for post-menopausal
