Urinary Incontinence Flashcards
3 classifications of Urinary Incontinence
Transient <6m
Chronic >6m
Functional- physical or cognitive impairment
4 subtypes of Chronic UI
Stress
Urge
Mixed
Overflow
RF for UI
Age
Obesity
Smoking/Pulmonary Dz (Chronic cough)
Pelvic Surgery
F: vaginal deliveries
M: BPH
Stress Incontinence pathogenesis
Pelvic floor musculature becomes lax and support of the bladder decreases
The Urethra becomes hyper mobile
Urge Incontinence pathogenesis
Detrusor Muscle hyperactivity due to interface between the Urothelial and interstitial cells and the PNS
Overflow incontinence pathogenesis
Blocked urethra
Bladder weakness caused by DM, EtOH, or nerve problem
BPH in men
Common Reversible causes of UI
DIPPERS Delirium Infection Pharmaceuticals Psych problems Excess fluid intake Restricted mobility Stool Impaction
Medical history to note when patients present with UI complaint
Fluid intake Frequency (>7 is abnormal) Nocturia Urgency Urine stream Straining
PE for UI
Abdominal exam looking for any masses, palpable bladder, CVAT
Urogenital exam looking for vaginal atrophy, dermatitis, pelvic organ prolapse
Do cough stress test
Cotton swap test for Stress incontinence
Stick a lubed cotton swab up the urethra and have the patient perform a valsalva maneuver, if the cotton swab creates >30 degree angle the urethra is hypermobile
Labs for UI
Urinalysis with microscopy
Post-void-residual test (>200ml abnormal)
Functional UI
cognitive, functional, or mobility issues cause incontinence despite everything being physiologically normal.
Stress UI treatment
Constipation management
Kegels
plugs (ouch)
weight loss
Urge UI pharmacologic treatment
Anticholinergics
Intravaginal estrogen for pelvic floor muscles
B3-agonist
Overflow UI pharm management
a-blockers
