lecture 12: urinary incontenence Flashcards
1
Q
define urinary incontinence (UI)
A
- urinary incontinence is not a normal change with aging
- it results from some age related changes, genitourinary pathology, comorbid conditions, and environmental obstacles
2
Q
DRIPP
A
- reversible causes
D = delirium
R = restricted mobility
I = infection, inflammation, impaction of stool
P = polyruia secondary to d.m., caffeien, volume overload
P = pharmaceuticals (diuretics, atuonomic agents, psychiatric drugs)
3
Q
Urge incontinence
A
- patients experience sudden strong urge to urinate
- this happens at frequent intervals
- the DETRUSOR muscle responds to small urinary volumes with contraction
- URINE IS CLEAR
- Post void residual to usually less than 50ccs
4
Q
treatment of urge incontinence
A
- Tx = kiegel exercises and bladder relaxation
- common meds = ditropan and detrol (anticholinergics)
- -> meds can cause constipation, dry mouth, and can affect CNS
5
Q
Stress incontinence
A
- patients lose urine when intraabdominal pressure increases as with coughing, laughing, or lifting
- this represents failure of sphincter mechanisms to remain closed during bladder filling
- often due to insufficient pelvic support in women and secondary to trauma from prostate surgery in men
6
Q
tx for stress incontinence
A
- kiegel exercises and alpha blockage with agents like sudafed
7
Q
overflow incontinence
A
- caused by outflow obstruction or impaired detrusor contractility
(volume builds up until gush of urine) - causes of impaired contractility = B12 deficiency, diabetes, tabes dorsalis, alcoholism, spinal diseases
- outlet obstruction: prostatic hypertrophy, urethral stricture, neoplasia, constipation, large cystocele
8
Q
mixed UI
A
- combined urge and stress incontinence is very common in older women
9
Q
functional UI
A
- this is caused by an inability or unwillingness to toilet because of physical, cognitive, psychological, or environmental factors
10
Q
Other more unusual causes
A
- bladder-sphincter dyssynergia (neurological/spinal cord injury), fistulas, reduced detrusor compliance, and recurrent cystitis
11
Q
evaluation
A
- history and physical exam
- precipitant urgency suggest detrusor overactivity
- Loss of urine wiht cough or strain suggests stress ui
- continuous leakage suggests sphincter weakness or overflow
- On physical exam, note functional status, mental status, orthostatic bp and heart rate along with bladder distention and impaction
- neuro exam looking for signs of cord compression like muscle wasting, hoffman, babinksi signs
- Sacral root integrity is reflexed by RECTAL TONE and PERINEAL SENSATION
12
Q
voiding record
A
- it can be useful for the patient to keep track of episodes of incontinence, voiding patterns, and associated factors
13
Q
standing full bladder test
A
- relaxing followed by coughing with resultant loss of urine strongly suggests stress UI
14
Q
Post void residual
A
have patient empty bladder and then meausre urine volumen left in the bladder by cath or scan
- normal is less than 50 ccs
15
Q
management
A
- consider non-pharmacologic therapies
- decrease caffeine, etoh, and evening fluid
- for detrusor instability, instruct on relaxation techniques and kiegel exercises. also timed toileting with gradually increasing intervals can be helpful
