Incontinence and Overactive Bladder

Question 1

What is incontinence?

Answer 1

Involuntary release of urine

Overactive bladder is sometimes used in place of incontinence, but frequency and urgency does not always lead to the involuntary loss of urine

Question 2

Type of Incontinence:

Stress Incontinence?

Answer 2

Muscles of the bladder are weakened with force to include cough, sneezing, heavy lifting, or prolapsed pelvic organs.

Question 3

Types of Incontinence:

Mixed Incontinence (overflow incontinence)?

Answer 3

Mixture of urge and stress incontinence, this may be associated with bladder outlet obstruction or obstruction present during the voiding process

Question 4

Types of Incontinence:

Urge Incontinence:

Answer 4

Strong sudden urge to urinate and the patient is unable to control urine resulting involuntary release sooner than expected.

Question 5

Pathophysiology:

The lower urinary tract is innervated by ____ and ___ neuronal complexes

Answer 5

The lower urinary tract is innervated by efferent and afferent neuronal complexes

Question 6

Pathophysiology:

What components of the urinary tract determine urination?

Answer 6

Central, peripheral and anatomic

Question 7

Pathophysiology:

Is the urge to void voluntary or involuntary control?

Answer 7

The urge to void is under voluntary control

Question 8

Pathophysiology:

What nerve maintains external sphincter and pelvic muscle tone?

Answer 8

Pedestal nerve

Question 9

Pathophysiology:

What nerve stimulates bladder contraction?

Answer 9

Pelvic nerve

Question 10

Pathophysiology:

What nerve stimulates internal sphincter closure and detrusor relaxation?

Answer 10

Hypogastric nerve

Question 11

What qualifies as overactive bladder?

Answer 11

Nocturia at a minimum of two times per night

Urinary urgency and frequency of at least eight times in 24 hour period

Question 12

Is overactive bladder a natural part of aging?

Answer 12

This is not a normal part of aging.
This condition is seen in the elderly population at higher rates.
Patients have a misconception that this is a normal part of aging

Question 13

What are the goals of therapy?

Answer 13

1. Reduction of urinary frequency, urgency, urinary retention
2. Decrease episodes of nocturia
3. Restore self-esteem and return to normal social functioning that had previously been interrupted by incontinence or overactive bladder symptoms
4. Improvement or resolution of symptoms

Question 14

What is first-line therapy for overactive bladder?

Answer 14

Anticholinergics/antimuscarinics

Question 15

How do anticholinergics/antimuscarinics work?

Answer 15

These medications cause an increased bladder capacity, decrease the intensity and frequency of bladder contractions and delay the initial urge to void.

Antagonizing the parasympathetic muscarinic receptors in the bladder with relative selectivity for the M3 and M1 subtypes.

*Oxybutynin is both an antimuscarinic and an antispasmodic as well as a local anesthetic.

Question 16

Name the anticholinergics/Antimuscarinics

Answer 16

Oxybutin (Ditropan)
Tolterodine (Detrol)
Darifenacin (Enablex)
Solifenacin (Vesicare)
Fesosterodine (Toviaz)

Question 17

What are some side effects of anticholinergics/Antimuscarinics?

Answer 17

Dry mouth
vision changes - blurred vision
Cognitive impairment
Urinary retention

Question 18

What medication class is used for enuresis in children?

Answer 18

Tricyclic antidepressants (TCA’s)

Question 19

What are the side effects of Tricyclic antidepressants?

Answer 19

These medications have a high-interaction potential when taken with other medications

Do not use MAOI within 14 days of the use of this medication or other TCA; this can cause serotonin syndrome

Question 20

What TCA is used for overactive bladder?

Answer 20

Imipramine (Tofranil)

Question 21

How do serotonin-NE reuptake Inhibitors work for overactive bladder?

Answer 21

Serotonin facilitates urine storage, augmenting parasympathetic innervation and inhibiting sympathetic innervation to the bladder, improving bladder control and urinary storage.

Question 22

What are the side effects of Serotonin-NE Reuptake Inhibitors?

Answer 22

Nausea within the first week

Question 23

What is an example of a SNRI for overactive bladder?

Answer 23

Duloxetine (Cymbalta)

Venlafaxine (Effexor)

Question 24

How do Alpha Adrenergic Antagonists work for overactive bladder?

Answer 24

Alpha Adrenergic Antagonists help to resolve symptoms of urinary obstruction, thus improving symptoms.
Used to treat BPH in males

Use of Tamulosin (Flomax) can be used to improve flow rate, and reduce bladder pressure for treatment of OAB.

Question 25

What are the side effects of Alpha Adrenergic Antagonists?

Answer 25

Dizziness
Weakness
Retrograde ejaculation

Question 26

What medications can exacerbate symptoms of OAB?

Answer 26

Diuretics
Alpha-adrenergic antagonists
Alpha-adrenergic agonists
Anticholinergics
CCB
narcotics
Anesthesia

Question 27

What are some factors that worsen the condition of OAB?

Answer 27

Stroke
Spinal cord injury
Diabetes
Sleep Apnea
Depression
Estrogen Deficiency
Prostate enlargement or cancer
UTI
Urinary Obstruciton

Question 28

What are some bladder irritants?

Answer 28

Alcohol
Caffeine
Tomatoes
Artificial sweeteners
Grapes
Carbonated beverages
Strawberries
Apple Juice
Vinegar
Weight loss supplements
Spicy foods

Question 29

How else do caffeine and alcohol affect OAB?

Answer 29

Alcohol and caffeine not only act as bladder irritants but also inhibit ADH release, which in turn, will increase the production of urine and contribute to urgency and frequency.

Question 30

What are some topics to take into consideration when choosing a treatment for OAB?

Answer 30

History and Physical
Medications previously were taken
Diet and nutritional considerations causing exacerbation of symptoms