Urinary Incontinence Flashcards
What is urinary incontinence?
Loss of voluntary bladder control resulting in urinary leakage
Is urinary incontinence more commonly a symptom or a diagnosis?
Symptom
__ out of 3 women over the age of 45 have some type of urinary incontinence
1 out of 3
_____ incontinence is described as experiencing the overwhelming need to urinate even if you jest went and not being able to hold it long enough to make it to the bathroom
Urge Incontinence
What is stress incontinence?
Urine loss during episodes of increased intra-abdominal pressure that puts pressure on the bladder resulting in urine leakage
What are examples of ‘things’ that can cause stress activities?
Coughing
Sneezing
Exercising
Laughing
Can stress and urge incontinence be seen together?
Yes, this is described as mixed incontinence
What is Unconscious/Overflow Incontinence?
Incontinence without urge or stress
Overactive Bladder (OAB) is the idiopathic instability or neuropathic hyperreflexia of what muscle?
Detrusor Muscle
Stress incontinence can often be a result of what two things?
Urethral Hypermobility
Intrinsic Sphincter Deficiency (IDS)
What are the THREE most common symptoms associated with urge incontinence?
Frequency
Urgency
Nocturia
What medications may be associated with urinary changes?
Anticholinergics
Alpha-Blockers
CCB
Sedavites
Should you ask about alcohol consumption in a patient with urinary incontinence?
Yes
What is a critical portion of the evaluation of urinary incontinence?
What types of things does this measure?
24 hr Voiding Diary
This measures input, output, times leaking, times voiding
What is the average amount of urine output in a 24 hour period?
1500 - 2500 mL
What is the average number of times a patient should void in 24 hours?
7 - 8 times
What is the average amount voided at one time?
250 mL
What are FOUR things to include in your physical examination for urinary incontinence (in females)?
Pelvic Exam
Q Tip Test
Standing examination
Estrogen Status
What ‘labs’ should you order when working up urinary incontinence?
Urinalysis
Urine Culture
What is one ‘study’ that is useful in working up incontinence, especially stress incontinence?
Urodynamics
What does a cystometry measure during urodynamic testing?
Pressure Flow
What is a urethral profile pressure measure during urodynamics?
Urethral closure pressure
What is a ‘leak point pressure’ during urodynamic testing?
Lowest pressure at which leakage occurs with straining
How does urge incontinence occur?
Nerve passages from the bladder to the brain are damage causing a sudden bladder contraction
Which would you expect larger volumes of urine to be ‘leaked’ out……
Urge or Stress Incontinence
Urge
What class of medications can be used to treat urinary incontinence?
Muscarinic Receptor Antagonists
T/F: Sacral Neuromodulation Interstim device placement can be utilized to manage urge incontinence
True
What are examples of ‘things’ that can lead to stress incontinence?
Pregnancy/Childbirth Radiation Trauma Surgery Hormonal Changes
How is stress incontinence diagnosed?
This condition needs to be proven under urodynamic studies that demonstrate urinary leakage when intra-vesical pressure exceeds the maximal urethral closing pressure in the absence of detrusor contraction
T/F: There are approved medications for stress incontinence management
False
There are no approved medications for this
What is the goal of stress incontinence treatment?
What are examples of these treatments?
Strengthen or aide the pelvic muscles that have been damaged.
Examples….
Pelvic Floor Exercises
Pessary Device
Surgery
What two muscles are the focus of kegel exercises?
Urogenital sphincter (increase urethral closure)
Levator Ani (Improves urethral support)
What muscles do pessary devices support?
Levator Ani Muscles
Surgical placement of what is often indicated in stress incontinence?
Sling
***Minimally Invasive surgery
T/F: Mixed incontinence is often treated with a combination of medications and surgery
True
