Urinary incontinence Flashcards
Nl bladder fx should
Store LRG volumes of UA at low pressures
Empty bladder completely
Continence is dependent on
Compliant reservoir
Efficent sphincter
Efficent sphincter Req two components
- Involuntary smooth muscle of bladder neck
2. Voluntary sk muscle of external sphincter
F- RFs of incontinence
Obesity Age Multiparity Vaginal Delivery Fam Hx
M- RFs of incontinence
Age Prostate Dz UTI Hx Constipation DM Neuro Dz
Urinary incontinence classified as
Transient - reversible
Established - low GU tract patho or age-related physiology
Transient incontinence causes
DIAPPERS
- delerium
- infection (symptomatic UTIs)
- atrophic vaginitis/urethritis
- Pharm - Rx
- psychologic factors
- excess UO
- restricted mobility
- stool impaction
MC transient cause in admitted pts - and other -
Delirium
-stool impaction
MC transient Rx causes
Diuretics Anticholinergics Psychotropics Opioids Alpha-blks (F) Alpha-agonist (M) CCB
Incontinence established causes
Detrusor overactivity (urge Incontinence)
Urethral incompetence
(Stress Incontinence)’
Urethral instruction
Detrusor underactivity (overflow Incontinence)’
Types of urinary Incontinence
Total Incontinence
Stress Incontinence
Urge Incontinence
Overflow Incontinence
Total Incontinence is?
Urinary loss at all times and in all positions - aka continuous incontinence
Total Incontinence is due to?
Anatomic ABNLs
- Lost sphincter efficiency
- Fistulas 2/2 pelvic/vag surgery or diverticulitis
TXT Total Incontinence
Surgery
Total Incontinence Hx
- Leakage degree
- Relation to activity
- Position/fullness of bladder
- Timing of onset
- progression
- PMH/PSH/Rx/OB hx
- supplements
- voiding Diary
Total Incontinence PE
GU - pelvic exam
GI - rectal exam
Neuro Exam
Bladder stress test
What is a stress test for the bladder?
Pt stands and coughs w/ full bladder
Incontinence Labs W/U
UA-Cx > UTIs
BUN/creatinine > renal Fx
PSA
Incontinence Special tests?
Post-void residual urine volume Cystogram Urodynamic studies (nit routine)
Purpose of Post-void residual urine volume test for Total Incontinence
Via urethral cath or U/S a PVR volume <50mL is NL
Purpose of cystogram for Total Incontinence
Evaluates fistulas or bladder neck for descent issues
Purpose of urodynamic studies is?
Cystometry studies
Uroflow testing
(Not routine)
What is stress incontinence?
Instant urine leakage in response to a stress maneuver
stress incontinence is aka?
Urethral incompetence
2nd MC cause if urinary incontinence in older women?
Stress incontinence
MC incontinence in men S/P radical prostatectomy?
Stress incontinence
Stress incontinence can coexist w/? and is ass/w?
detrusor muscle over activity
- Pelvic floor laxity
- Poor vesicourethral sphincteric unit
Stress incontinence leakage occurs the worse during?
the day
Stress incontinence stress test result?
Positive
Multiparous women, pelvic surgery and prostate surgery are all ass/w?
- Pelvic floor laxity
- Poor vesicourethral sphincteric unit
Stress incontinence TXT?
Kegal exercises
lifestyle mod - limit caffeine/fluid intake or weight loss
Pessaries or vaginal cones
Sling surgery
Urge incontinence is
Overactive bladder (detrusor over activity) Urinary leakage after intense urge
2/3 of geriatric incontinence is due to?
Urge incontinence
Urge incontinence w. men MC ass/w?
urethral obstruction from BPH
Sudden unexplained onset of Urge incontinence reqs?
Cystoscopy or urine cytology to R/O bladder stones/tumor
Urge incontinence 1st line TXT?
Bladder training (scheduled voiding while gradually lengthening time between voids w/ relaxation techqniues)
Urge incontinence other TXT?
Lifestyle modifications (Wgt loss, caffeine reduction) Timed/prompted voiding for cognitively impaired Kegal exercises
Urge incontinence Rx TXT?
Antimuscarinics 1st (SEs- delirium, dry mouth, retention)
-Solifenacin
-Oxybutynin
-Fesoterodine
-Tolterodine
2nd - Antispasmodic (SEs- less dry mouth, Cardiac efx)
3rd - Onabotulinum toxin A - inject detrusor muscle
Least common incontinence
Overflow incontinence
Overflow incontinence is usually due to?
Idiopathic or Sacral LMN dysfx
Somtimes chronic urinary retention (over-distended bladder)
Overflow incontinence S/S
Urinary frequency
Nocturia
Freq leakages of small volumes
Overflow incontinence postvoiding residual urine volume?
> 450mL
Overflow incontinence TXT
Augmented voiding techniques
- double voiding/suprapubic pressure
Intermittent or indwelling cath
Urethral obstruction is usually due to?
BPH
Urethral stricture
Bladder neck contacture
Prostatic cancer
What is a common cause of established urinary incontinence in older men?
Urethral obstruction
Urethral obstruction S/S
Post-void dribbling Urge incontinence-(2/3 pts coexist detrusor overactive) Overflow incontinence (obstuct > retain > overflow)
Urethral obstruction TXT
Relieve obstruction
- surg decompress (most effective -esp retain/BPH)
- intermittent/indewlling cath (non-op UA retain)
- A-blks (Terazosin, prazosin, tamulosin)
General TXT strategies
Kegal exercises Wgt loss Reduce fluids, caffeine, ETOH, Tob cessation no evening fluids TXT constipation TXT pulm Dz (PVT valsalva coughs) Pads/briefs
Kegel exercise how to
squeeze pelvic floor muscles hold 3 seconds/release 3 seconds RPT 10x Each week, add 1 second until 10 seconds each time Work up to 3 sets everyday
Best tool for evaluating incontinence?
bladder/voiding diary
