Week 6 Menopause, ED, Incontinence, and UTI's Flashcards
Signs and Symptoms of UTI
dysuria, frequency, urgency, suprapubic tenderness, low back pain (pyelonephritis), incontinence, change in urine character (color change, hematuria, change in odor), and mental status changes
Risk Factors for UTI
women > men increases with age post-menopausal indwelling catheters, urethral or condom catheters urinary or fecal incontinence cognitive impairment neurological impairment Diabetes, unprotected and anal sexual intercourse poor perineal hygiene functional disability renal stones alkaline urine prior ATB therapy genetic predisposition BPH, prostatitis, urinary retention, institutionalization
Most common bacteria that causes UTI
E. coli
Second most common bacteria that causes UTI
staph saprophyticus
Other organisms that cause UTI
klebsiella, proteus, and enterococcus, serratia, pseudomonas and staph aureus
Diagnostic Criteria for UTI
UA + LE and/ or nitrates, pyuria (>10 neutrophils per hpf)
UTI symptoms
Urine culture + for bacteria
Asymptomatic bacteriuria (ABS)
urinary culture with more than 105 colony forming units with no corresponding urinary tract symptoms is prevalent in the older adult (esp. in nursing homes) and is NOT diagnostic
Treatment is not recommended
Medications for UTI uncomplicated in women
- nitrofurantoin (Macrobid) 100 mg BID x 3-7 days
- SMZ-TMP (Bactrim DS) 160 mg TMP/800 mg SMX BID x 3 days
- fosfomycin 3 grams x 1 dose
Why is 3 day ATB treatment recommended for uncomplicated UTI in women?
to prevent development of candida vaginitis and nonadherence
Uncomplicated UTI in men ATB Treatment
§ Fluoroquinolone or SMZ-TMP DS x 7 days
Older men may need longer therapy (10-14 days)
Uncomplicated vs complicated UTI treatment
○ Uncomplicated UTI - 3-7 days of ATB tx
Complicated UTI - 10-14 days of ATB tx
What medication is used for relieve dysuria
Phenazopyridine 200 mg q 8 hrs x 2 days
Complications of untreated UTI
pyelonephritis sepsis shock death urethritis in men can lead to urethral strictures, periurethral abscess, urethral diverticula and fissures if left untreated
Incontinence Risk Factors
- Female»_space; male
- vaginal deliveries, multiparity, hysterectomy
- enlarged prostate, BPH, proctectomy
- living in LTC or nursing home
- increases with age
- cognitive impairment
- physically frail with functional limitations
- pelvic muscle weakness
- estrogen depletion (post-menopause)
- increased intra-abdominal pressure (pelvic organ prolapse, pregnancy, tumors, obesity)
- diabetes and CHF
- neurological diseases (stroke, MS, Parkinson’s, spinal cord injury)
- fecal impaction
- poor fluid intake or excessive fluid intake
- smoking
- depression
- cancer
Medications that can cause incontinence
- cholinergics
- anticholinergics
- diuretics
- antispasmodics
- opiates
- hypnotics
- calcium channel blockers
- ACE inhibitors
- alcohol and caffeine
Stress incontinence
urine leakage associated with increased abdominal pressure from laughing, sneezing, coughing, climbing stairs or other physical stressors increasing abdominal pressure
Urge incontinence
urine leakage associated by or immediately preceded by the feeling of an urgent need to void
also known as detrusor instability
Mixed incontinence
a combination or stress and urge incontinence, marked by involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing
Overflow incontinence
urine leakage when the bladder is over distended and may result in incomplete bladder emptying
- symptoms can present as constant dribbling, frequency, hesitation when initiating urination and nocturia
- often associated with bladder outlet obstruction, such as BPH in men and pelvic organ prolapse in women
Functional incontinence
the inability to hold urine due to reasons other than neurological and lower urinary tract dysfunction including delirium, psychiatric disorders, UTI and impaired mobility
Overactive Bladder (OAB)
urine storage symptoms such as urgency, frequency, and nocturia and may or may not be accompanied by urge incontinence
associated with involuntary contractions of the detrusor muscle
What medications help with urge/stress incontinence and overactive bladder?
Anticholinergics/antispasmodics
- tolterodine (Detrol LA)
- oxybutynin (Ditropan XL, Urotrol)
- solifenacin (VESIcare)
- darifenacin (Enablex)
- trospium chloride (Sanctura XR)
- transdermal oxybutynin (Gelnique)
- fesoterodine (Toviaz)
What medications help treat BPH and urinary incontinence in men??
alpha-1 adrenergic blockers
- tamsulosin (Flomax)
- terazosin (Hytrin)
- doxazosin (Cardura)
What medications treat OAB and urge incontinence ?
TCA’s
imipramine (Tofranil)
amitriptyline (Elavil)
What medication is used to treat OAB that does not respond to anticholinergics?
Botulinum toxin (Botox) injection
Treatments recommended for stress incontinence?
alpha-blockers
(men), SNRI’s, surgery
Treatments recommended for urge incontinence?
anticholinergics
kegels
bladder training
Treatments recommended for overflow incontinence
treat underlying cause of bladder outlet obstruction and urinary catheterization
Treatment of functional urinary incontinence
scheduled toileting
Treatment of mixed incontinence
anticholinergics
Causes of hematuria from urethra
urethritis (gonococcal or nongonococcal)
stricture
calculus
trauma
Causes of hematuria from prostate/male GU tract
infection (prostatitis, epididymitis)
BPH
tumor
Causes of hematuria from kidney
infection nephrolithiasis renal cell cancer trauma glomerular disease allergic interstitial nephritis (Drug-induced)
Causes of hematuria from ureters
nephrolithiasis
tumor
endometriosis
Causes of hematuria from bladder
infection calculus tumor endometriosis drugs (hemorrhagic cystitis)
Causes of pseudohematuria
menstrual contamination phenothiazines red food dye beet consumption quinine rifampin hemoglobinuria