Urinary Incontinence Flashcards
What is the stretchable smooth muscle of the bladder, what neurotransmitter is associated with it, which receptor types
Detrusor, acetylcholine, muscarinic (M2 and M3)
T/F: The internal sphincter and external sphincter are under voluntary control
False: The External sphincter is skeletal muscle under VOLUNTARY control while the internal sphincter is a continuation of smooth muscle of the bladder and not a true sphincter
What occurs in the bladder before urination in the parasympathetic pathway
Urine fills bladder and pressure increases -> bladder stretches -> bladder contraction and opening of internal sphincter/relation of external sphincter and “urge” sensation
What causes the holding of urine when the urge is present
Tightening of the external sphincter (overriding the parasympathetic stimulation) and the pelvic floor muscles
What exercises can strengthen the Pelvic floor muscles
Kegel
What type of nerve stimulation is associated with the internal sphincter, bladder relaxtion
alpha-1, beta-3
What are the four types of Urinary Incontinence
Functional, Urge, Stress, Overflow
T/F: A patient can have more than one type of urinary incontinence and stress incontinence is the most common
False: A patient CAN have more than one type of incontinence BUT the most common type of incontinence is urge UI
What is functional incontinence
Urine leakage due to inablility to reach the toilet due to physical and cognitive impairment
What are causes of functional incontinence
physical disability, dementia,MS, drowsiness or meds affect balance (diazepam etc.)
What is urge incontinence
Urine leakage due to inability to control bladder when feeling of fullness is perceived
What is the most common causes, other causes
Idiopathic (unknown)/ detrusor instability, CNS disorders (stroke)
What is the pathophysiology of Urge UI
OVER SIGNALING to the detrusor by acetylcholine (parasympathetic) -> increased bladder contractions -> more frequent urge to urinate
What is stress incontinence, how is it identified
Urine leakage due to increases in intraabdominal pressure along with weakness of internal/external sphincter, urine leakage due to coughing, laughing, exercise etc.
T/F: Losing weight is beneficial to controlling urge and stress UI
True
What is overflow UI
Leakage of urine (small amounts) from mechanical forces on an over stretched bladder or from urinary retention on bladder
What are common causes of overflow UI
Obstruction by prostate (males), spinal cords injury, diabetes, atonic bladder, meds (opiates, anticholinergics)
What is the first line therapy for types of UI except in cases of urinary obstruction
Behavioral approaches
What are non pharmacological strategies
Kegel exercises, drinking up to two liters per day, avoid caffein smoking and alchohol, weight loss, diuretics early in the day
T/F: Behavioral is more efficacious and there is less want to change therapy
True
Which UI is most associated with drug therapy
Urge UI
What classes of drugs are used in Urge UI, MOA
Antimuscarinics (muscarinic antagonists), relaxation of detrusor allowing greater volumes of urine before the urge of urination
What is the beta-3 agonists used in Urge UI
Mirabegron (Myrbetriq)
T/F: Meds for UI should only be used for up to 4 to 8 weeks then reevaluated at 3 month intervals, not for long term use
True
What antimuscarinics should patinets NOT use for urinary incontinence
Propantheline, Dicyclomine, Imipramine, Flavoxate
What are the antimuscarinics used in UI
Oxybutynin, tolterodine, festoterodine, solifenacin, darifenacin, trospium
What are the adverse effects of anticholinergicsw
dry mouth, constipation, vision impariment, tachycardia, drowsiness
What anticholinergic is the most reasonable first line
Tolterodine`
What are drug-drug interactions to be concerned with when using anti-muscarinics
Fluoxetine, Sertraline, Fluvoxamine, erthymyocin/clarithryomycin, ketoconazole/fluconazole, grapefruit juice (ALL INTERACT WITH CYP 3A4)
What drug should be avoided when using Tolteridine
Antacids by at least 4 hours
Which antimuscarinic should be taken on an empty stomach
Trospium
T/F: Topical Estrogens make stress UI worse
True
What antidepressant is approved for Urge incontinence
Duloxetine
How would overflow incontinence be treated
Catheterization or procedure
T/F: Chronic diarrhea needs to be treated before overflow incontinence
False: Chronic CONSTIPATION needs to be treated before overflow incontinence
