Urinary incontinence Flashcards
several types?
stress, urgency, mixed and overflow.
Stress incontinence?
sx: leaking with valsalva maneuver ( coughing, sneezing, laughing).
tx: lifestyle modification, pelvic floor exercises, pessary, pelvic floor surgery.
Urgency incontinence?
sx: sudden, overwhelming, or frequent need to void.
sudden need to void followed by immediate loss of urine due to detrusor overactivity.
sx occur throughout the day and night and are unrelated to the increases in the intraabdominal pressure.
tx: lifestyle modification, bladder training ( involves resisting the urge to void for progressively longer time intervals to increase bladder capacity), antimuscarinic drugs.
mixed incontinence?
features of stress ad urgency incontinence.
tx: variable treatment depending on predominant symptoms.
overflow incontinence?
constant involuntary dribbling and incomplete emptying.
tx: identification and correction of underling cause, cholinergic agonists, intermittent self-catheterization.
urgency urinary incontinence risk factors?
age > 40 ys old, prior pelvic surgery (ex: midurethral sling).
all patients of urinary incontinence?
require initial evaluation for urinary retention (ex: postvoid residual) and infection ( urinalysis).
first-line treatment for any urinary incontinence?
includes bladder training and pelvic floor muscle (kegel) exercises.
patients who do not respond to first-line treatment?
pharmacologic therapy.
the detrusor muscle is mediated by the parasympathetic nervous system, therefore antimuscarinic meds ( ex: oxybutynin) which reduces the acetylcholine activity helps increase bladder capacity and decrease destrusor contractions hence decreased urgency sensation.
patients unable to tolerate antimuscarinic therapy?
adverse effects ( dry mouth, constipation, blurry vision) may benefit from a beta- adrenergic agonist ( ex: mirabegron).
