Urinary Incontinence - Dr. Miller Flashcards
Transient Urinary Incontinence
sudden and less then 6mos
can be reversed
chronic Urinary Incontinence 4 types
from stress, urge, mixed, overflow
Stress UI
coughing, sneezing, Physical activity (more in women)
Urge UI
sudden need to or desire to void peeing
—-> causing leakage
Mixed UI
mix stress and urgency UI
Overflow UI
urinary retention from detrusor underactivity or outflow obstruction (BPH) —-> causing leakage
Functional UI
from cognitive limits or physical limits –> pee themselves
risks of UI
- age
- obesity
- pulmonary diseases, smoking
- DM
- many vaginal deliveries
- BPH
- medications
- neural problems
what keeps urine from leaking
pelvic floor muscles
external sphincter
urethral P
during stress or cough what happens
Hammock hypothesis = urethra is compresses on the endopelvic fascia —-> stops pee
UI what muscle contracts more
Detrusor Muscle over active
overflow UI what happens
bladder gets so full it leaks out
= weak muscle
= blockage (BHP)
= DM
UI SX
= amout and type fluid intake = urgency = can they feel full bladder = unable to empty = pain = drug intake
UI Physical assessment
= BMI = mental status = bladder location palpation = Urigenital examination = CVA tenderness = rectal tone (innervation) = cough stress test ( = Prostate exam
testing for UI
- UA + microscopy (rule out UTI, glucose, protein, cr)
- dip stick or sx—-> Urine culture
- Post void residual volume (PVR)= how much bladder emptied (abnormal >200mL)
- voiding diaries
- pad testing
urodynamic studies do what
if dx is uncertain after evaluation**
= measures P in bladder and of muscles and nerves and all that
= for deciding if you should do an invasive irreversible tx
rule out reversible causes of UI HOW
DIPPERS
- Delirium
- Infection (acute UTI)
- Pharm : Drugs
- Psychological morbidity
- Excess fluid intake
- Restricted mobility
- Stool impaction (constipation)
UI TX
STRESS : drink water, manage C, weight loss, Pelvic Floor Muscle strengthening —-> Kegel exercise)**
URGE : medicines to lower nerves (antimuscar, estrogen cream)
OVERFLOW: a-adrenergic antagonists** —–> decrease prostate size
behavior changes for UI
carbonated drinks, caffeine, alcohol limited
weight loss + Pelvic floor strength for stress UI
stop smoking , regular exercise
stress UI meds
none
urge UI meds
- vaginal estrogen when with urogenital atrophy and LUTS
- Anticholinergic to decrease detrusor overactivity (OXYBUTYNIN = Antimuscarinic B2)*****
- botox
complications of UI
sexual dysfunction, poor sleep, , social isolation