Urinary Incontinence (Miller) Flashcards
What is the main risk factor for urinary incontinence in men?
Benign prostate hypertrophy (BPH)
What are common risk factors for urinary incontinence in women?
Parity (multiple vaginal childbirth deliveries)
Menopause
What are some common risk factors for urinary incontinence?
Age (increase with age)
Obesity
Smoking/pulmonary disease (the chronic cough)
Family Hx
PSH of pelvic surgery
Meds
Dementia
What is the main reason as to why UIs are underreported?
UI is highly prevalent but sigmatizing which is why it is underreported. Prevalence range (5-72%)
Urinary Incontinence (UI)
complaint of involuntary loss or leakage of urine
What are the three class of UI?
- Transient UI - last < 6 months (can be reversed)
- Chronic UI (4 subtypes)
- Functional UI - UI due to physical or cognitive impairment
What are the 4 subtypes of chronic UI?
- Stress UI
- Urge UI
- Mixed UI
- Overflow UI
Stress UI
leakage of urine with coughing, sneezing, or physical exertion (women)
Urge UI
AKA overactive bladder
urine leakage with a sudden compelling desire to void (women and men)
Mixed UI
co-existence of stress and urgency
Overflow UI
urinary retention from detrusor under-activity or outflow obstruction (more common in men due to BPH)
Pathophysiology of Stress UI
Your pelvic floor muscles are weak and no longer support your pelvic organs as they should. This muscle weakness means that you’re more likely to accidentally leak urine when you move around. (coughing, sneezing, laughing)
Pathophysiology of Urge UI
AKA overactive bladder is caused by increased connectivity and excitability of both detrusor smooth muscle and nerves (ach released). Increased excitability propagates and generates uninhibited contractions
Pathophysiology of Overflow UI
when the bladder becomes so full and distended that urine leaks out
What are the 3 common causes of overflow UI
- blocked urethra
- bladder weakness (diabetes, alcohol, nerve impairment)
- enlarged prostate (BPH)
DIPPERS assessment
Reversible causes of UI: (usually causes transient UI)
Delirium
Infection
Pharmaceuticals
Psych morbidity
Excess fluid intake
Restricted mobility
Stool impaction
Refer to a specialist urologist if there is any:
Bladder pain
Pelvic organ prolapse
Fistula
Neurological symptoms
Malignancy
Recurrent UTI
Post void residual volume >50 mL
Insensible loss
Stress UI symptoms
Symptoms with coughing, sneezing, exercise
No nocturia
Small volume leakage on voiding daily (5-10mL)
Positive cough stress test
Post void residual volume < 50mL
Urge UI symptoms
Symptoms of urgency
Variable volume loss on voiding diary
Frequency and nocturia typical
Negative cough stress test
Post void residual volume < 50mL
Mixed UI symptoms
Symptoms with both physical activity and urgency
Variable volume loss on voiding diary
Positive cough stress test
Post void residual volume < 50 mL
What are the 3 incontinence questions you MUST ask if you suspect UI>
- During the past 3 months, have you leaked urine (even a small amount)?
- During the past 3 months, when did you leak urine? (choose all that apply)
- During the past 3 months, when did you leak urine most often? (choose only one)
What are two common meds that can cause UI?
Diuretics
Lithium (causes polyuria via induced diabetes insipidus)
UI physical exam
Functional assessment (mental status/mobility/BMI)
Abdominal exam (assess mass, palpable bladder, CVA)
Urogenital exam
Urological test
Urinalysis with urinary microscopy
Urine culture
+/- post void residual volume (PVR) - measures completeness of emptying
Voiding diary
pad testing (worn for 24 hours; positive when >4g)
Urodynamic Studies
According to the American Urogynecologic Society these studies are NOT recommended in the initial workup of an uncomplicated overactive bladder patient.
Indicated if: incontinence dx is uncertain after initial assessment or symptoms do not correlate with physical findings.
Functional UI
caused by cognitive, functional or mobility difficulties that impair pt ability to use the bathroom W/O bladder or neurological impairment.
Stress UI treatment
There is no recommended pharmacological treatment, but there is recommended conservative management
Appropriate fluid intake
Constipation management
Electrical stimulation
Mechanical devices
Pelvic floor muscles strengthening (training)
Smoking cessation
Weight loss
Can have stress incontinence surgery
Urge UI treatment
Antimuscarinics
Intravaginal estrogen
Mirabegron (B3 adrenergic agonist for women with contraindications)
Invasive interventions:
Neuromodulation
Intravesicle Botox injection
Overflow UI treatment
Alpha-adrenergic antagonists
Invasive treatments for UI
Stress incontinence surgery (stress UI)
Neuromodulation (urge UI)
Intravesicle Botox injection (urge UI)
Major UI complications
Poor quality of life (social isolation, sexual dysfunction, poor martial relationships, poor sleep)
Burden to family caregivers
Increased rates of depression (both patients and caregivers)
