Urinary Incontinence (Final)

Question 1

this is an involuntary loss of urine

Answer 1

urinary incontinence

Question 2

what are the different types of UI

Answer 2

• stress
• urge
• overflow
• functional
• mixed (stress & urge)
• iatrogenic

Question 3

is urinary continence more common in men or women?

Answer 3

women

Question 4

in a patient who does NOT have urinary incontinence, is their intravesicular pressure smaller or bigger than the intraurethral pressure

Answer 4

smaller

Question 5

in a patient who has urinary incontinence, is their intravesciular pressure smaller or bigger than the intraurethral pressure

Answer 5

bigger

Question 6

what are the 2 main urological causes of urinary incontinence

Answer 6

1. inability to store urine
   - bladder contracts too often
   - sphincter cannot contract sufficiently to allow the bladder to store urine therefore bladder never fills to capacity
2. inability to void urine
   - bladder unable to contract appropriately
   - possible obstruction

Question 7

what are some risk factors to developing urinary incontinence

Answer 7

• caffeine/fluid intake
• immobility
• bowel problems (e.g. constipation)
• smoking
• menopause
• medications
• UTIs

Question 8

this type of urinary incontinence is characterized by a transient loss of small amounts of urine with increased abdominal pressure.
- from coughing, bending, laughing

Answer 8

stress incontinence

Question 9

besides increased abdominal pressure, what is the physiological cause of stress incontinence

Answer 9

urethral sphincter weakness

Question 10

what are some risk factors specific to stress incontinence that may increase abdominal pressure

Answer 10

• pregnancy
• vaginal childbirth
• obesity

Question 11

this type of urinary incontinence is also caused overactive bladder, unstable bladder or spastic bladder. it is the most common type in the elderly

Answer 11

urge incontinence

Question 12

what is the physiological cause of urge incontinence

Answer 12

abnormal bladder contractions because of overactive detrussor

Question 13

which type of urinary incontinence can be caused by stroke, parkinsons, MS, diabates, or spinal cord damage

Answer 13

urge incontinence
- these can cause detrussor instability

Question 14

this type of urinary incontinence occurs when the intravesicular pressure exceeds intraurethral pressure (only at HIGH volumes). this is common in males with BPH due to obstruction

Answer 14

overflow incontinence
O = obstruction & O = overflow

Question 15

what are some causes of overflow incontinence

Answer 15

• bladder outlet obstruction (BPH, prostate cancer)
• diabetic neuopathy, spinal cord lesions below T-11
• drugs (muscle relaxants, CCBs, anticholinergics, alpha-agonsits)

Question 16

this type of urinary incontinence is known as the inability of a normally continent person to reach the toilet in time to avoid an accident. not caused by bladder or urethral specific factors

Answer 16

functional incontinence

Question 17

what are some causes of functional incontinence

Answer 17

• MSK limitations (joint pain, RA)
• cognitive impairments

Question 18

what are some causes of urinary incontinence that have no specific urogenital pathology

Answer 18

think DIAPERS
D - delirium
I - infection
A - atrophic urethritis / vaginitis
P - pharmaceuticals / psychiatric issues
E - excessive urinary output
R - restricted mobility
S - stool impaction

Question 19

this urinary continence is known as incontinence related to medication use

Answer 19

Iatrogenic incontinence

Question 20

what are some rx drugs that contribute to incontinence

Answer 20

think 3A’s, 2B’s & 1C, D & N
3 A’s
- alpha-agonsits
- alpha-blockers
- anticholinergics
2 B’s
- beta-agonsits
- beta-blockers
1 C, D & N
- CCBs
- diuretics
- narcotics

• alcohol, antihistamines & caffeine are some other drugs that may also contribute to incontinence

Question 21

select all that apply:
which urinary incontinence would present as the inability to store urine
a) stress
b) urge
c) overflow
d) functional

Answer 21

a and b

Question 22

select all that apply:
which urinary incontinence would present as the inability to reach the toilet
a) stress
b) urge
c) overflow
d) functional

Answer 22

d

Question 23

select all that apply:
which urinary incontinence would present as the inability to empty bladder
a) stress
b) urge
c) overflow
d) functional

Answer 23

c

Question 24

what urinary incontinence is most likely if the patient is dry overnight

Answer 24

stress incontinence

Question 25

what urinary incontinence is most likely if the patients primary complaint is urgency, frequency (> 8 episodes/day) & nocturia

Answer 25

urge incontinence

Question 26

what urinary incontinence is most likely if the patients primary complaint is suprapubic tenderness with low urinary flow rates and the patients has a palpable or percussable bladder

Answer 26

overflow incontinence

Question 27

what urinary incontinence is most likely if the patient primary complaint is early morning incontinence or having an accident on the way to the toilet

Answer 27

functional incontinence

Question 28

what are some screening questions to ask patients who are possibly experiencing urinary incontinence

Answer 28

- have you leaked urine in the past 3 months - do you ever lose urine when you dont want to - how often do you leak urine - when do you leak urine - do you ever leak urine when you cough, laugh or exercise - do you ever leak urine otw to the bathroom - do you ever use pads, tisse or cloth in your underwear to catch urine - do you ever feel that your unable to completely empty your bladder

Question 29

this is helpful when performing an assessment of symptom pattern and response to therapy. should be completed for at lease 3 days

Answer 29

bladder diary

Question 30

true or false: non-pharm tx is only used in adjunt to pharmacological treatment for urinary incontinence as the medications are very effective

Answer 30

false - first line is always 1st line because treatments are only modestly beneficial and have a/e

Question 31

what are some non-pharm recommendations for urinary incontinence

Answer 31

- prompted voiding - bladder training - pelvic floor exercises - vaginal weight training - pessary

Question 32

true or false: any drug used to treat incontinence can make it worse if the diagnosis is wrong or if the patinet has more than one type of incontinence

Answer 32

true

Question 33

this is a treatment option for stress incontinence, but overall evidence supporting its use is weak - may offer some benefit in women who also have vaginal atrophy

Answer 33

vaginal estrogens e.g. conjugated estrogen vaginal cream, vaginal ring, or vaginal tablet

Question 34

what are some a/e of vaginal estrogens

Answer 34

- vaginal discharge - local irritation/pruritis - spotting

Question 35

this is a treatment option for stress incontinence. studies have demonstrated reduction in urinary incontinence and increased QoL - but does not have an indicaition for UI.

Answer 35

duloxetine

Question 35

what are some a/e of duloxetine

Answer 35

- nausea - dizziness, insomenia, h/a - increased BP - constipation and dry mouth - risk of suicidal ideation

Question 36

this medicaation is not recommended for urinary incontinence therefore should only be used when all else fails. it wor,s by increasing intraurethral sphincter tone

Answer 36

pseudophedrine

Question 37

this is a class of treatment option for urge incontinence. it is the preferred treatment option if the patient fails non pharm. it may only reduce urination by 1 ep/day. it increases bladder capacity/storage

Answer 37

antimuscarinincs

Question 38

this antimuscarinic can cause a blockade of M1 receptors in the brain which can result in sleepiness and cognitive impairment

Answer 38

oxybutynin

Question 39

blockade of these receptors present in the detrusor muscle results in bladder relaxation and therefore less urinary incontinence

Answer 39

M3

Question 40

blockade of M3 receptors in other areas of the body besides the prostate can lead to what s/e?

Answer 40

constipation, dry mouth

Question 41

Darifenacin is the antimuscarinic with less CNS s/e. why?

Answer 41

its lipophilicity is low, it has a higher molecular weight and it has a postiive charge therefore it is less likely to cross the BBB and cause CNS s/e

Question 42

this antimuscarinic is the oldest agent with proven efficacy; considered the "gold standard" to which other therapies are compared to

Answer 42

oxybutynin

Question 43

what is an adequate trial of oxybutynin to see maximum benefit

Answer 43

4 weeks

Question 44

this antimuscarinic is a first line treatment for urinary incontinence. it is better tolerated with lower incidence of anticholinergic s/e compared to oxybutynin.

Answer 44

tolterodine

Question 45

true or false: dosage adjustment is reauired for renal/liver impairment in tolterodine

Answer 45

true

Question 46

what is an adequate trial of tolterodine to see maximum benefit

Answer 46

8 weeks

Question 47

this antimuscarinic is slightly more selective for M3 than M1. it is better tolerated than oxybutynin and tolterodine with regards to anticholinergic s/e

Answer 47

solifenacin

Question 48

this antimuscarinic is a prodrug with the same active ingredient as tolterodine. it should not be chewed or crushed b/c extended release and contains soya lecithin this should be avoided in patients with a soy or peanut allergy

Answer 48

fesoterodine

Question 49

true or false: fesoterodine requires dosage adjustment in renal and liver impariment

Answer 49

true

Question 50

this antimuscarninc may produce less anticholinergic s/e than others and should be taken on an empty stomach

Answer 50

trospium

Question 51

this antimuscarinic is the most M3 selective. can be taken with or without food. it is contraindicated in patients with urinary retention, gastric retention and uncontrolled narrow angle glaucoma

Answer 51

darifenacin

Question 52

what are some s/e of darifenacin since it is M3 selelctive

Answer 52

dry mouth and constipation - least likely to cause CNS s/e!!!!!

Question 53

this is a treatment option for urinary incontinence that acts on beta-3 receptors therefore relaxes bladder and increases its capacity. it is an alternative to antimuscarinics if they are not tolerated or contraindicated.

Answer 53

mirabegron (myrbetriq)

Question 54

what are some a/e associated with mirabegron (myrbetriq)

Answer 54

- hypertension - tachycardia - nasopharyngitis - UTIs

Question 55

this medication is a moderate inhibitor of CYP 2D6 and a weak inhbitor of p-gp. can increase digoxin and dabigitran levels and may be QT prolonging

Answer 55

mirabegron (myrbetriq)

Question 56

what is the therapy of choice in overflow incontinence who have chronic retention due to BPH

Answer 56

surgery * treatment relates to BPH management (alpha-adrenergic antagonists and 5alpha-reducatse inhibitors)

Question 57

what is the best way to prevent urinary incontinence in pregnancy

Answer 57

pelvic floor muslce training