Urinary Incontinence

Question 1

incontinence

Answer 1

involuntary loss of urine

• not a normal part of aging

Question 2

transient/new onset incontinence causes (8)

Answer 2

DIAPPERS:

• delirium
• infection
• atrophic urethritis
• pharmaceuticals (ex. diuretics)
• psychological
• excess urine output
• restricted mobility
• stool impaction

Question 3

stress incontinence

Answer 3

• small urine loss during sneezing, laughing, exercise, etc.
• due to weakened external sphincter and pelvic floor, increased intra-abdominal pressure
• common in: women under 60 (pregnant or post-menopause), men after prostate surgery, obesity

Question 4

urge incontinence

Answer 4

• overactive bladder causes loss of large amounts of urine
• due to detrusor instability (muscle spasms) and internal sphincter weakness
• common in older men
• can be caused by bladder irritants, diuretics

Question 5

overflow incontinence

Answer 5

• “dribbling” or constant losses of small amounts of urine
• due to overextended bladder muscles and poor tone; overflow of retained urine
• common with DM, BPH, meds like calcium channel blockers or anticholinergics

Question 6

functional incontinence

Answer 6

• physical or psychological factors impair ability to get to toilet
• common in frail elderly, nursing home residents, those with dementia

Question 7

imaging procedure for stress incontinence

Answer 7

voiding cystourethrogram - fill bladder with dye to visualize, ask pt. to cough/laugh

Question 8

physical assessment for incontinence

Answer 8

• bladder distention - palpate, percuss, bladder scan
• bowel sounds - may be hypoactive
• assess mobility, cognition
• pelvic or rectal exam

Question 9

lifestyle modifications for incontinence

Answer 9

• smoking cessation, alcohol and caffeine reduction
• weight reduction
• bowel management
• avoid bladder irritants: carbonated beverages, dairy products, citrus fruits/juices, spicy foods, tomatoes, artificial sweeteners
• appropriate fluid intake

Question 10

non-pharmacologic treatment for incontinence (4)

Answer 10

• scheduled voiding regiments, bladder training
• pelvic floor muscle strengthening - Kegel exercises + biofeedback, electrical stimulation, waking programs
• anti-incontinence devices - pessaries, condom cath, external clamps/plugs
• supportive devices - raised toilet seats, gait training, modified clothing, absorbent pads

Question 11

Kegel exercises

Answer 11

• 15 rapid contractions of pelvic floor muscle, 1-3 sets per day
• good for urge and stress incontinence

Question 12

meds for incontinence (6)

Answer 12

• anticholinergics (oxybutynin/Ditropan) for urge/overactive bladder
• topical estrogen for stress
• antispasmodics
• alpha agonists
• beta blockers
• SSRIs - anticholinergic effects