Approach to Urinary Incontinence

Question 1

what is transient UI?

Answer 1

arises suddenly, lasts <6 months and can be reversed

Question 2

What is stress UI?

Answer 2

leakage of urine with coughing, sneezing, physical exertion

(seen in women)

Question 3

What is urge incontinence?

Answer 3

urine leak with with sudden urge to void

(women and men)

Question 4

What is mixed UI?

Answer 4

combo of stress and urgency

Question 5

What is overflow UI?

Answer 5

retention from detrusor underactivity or outflow obstruction

(men due to prostate enlargement)

Question 6

What is functional UI?

Answer 6

incontinence in the setting of physical or cognitive impairment which limits mobility or ability to process info about bladder fullness

Question 7

What are some common risk factors for incontinence?

Answer 7

age

obesity

smoking

parity and menopause (women)

BPH (men)

Question 8

what is the pathophysiology for stress UI?

Answer 8

pelvic floor musculature and endopelvic fascia weakness

Question 9

what is the pathophysiology for urge incontinence

Answer 9

detrusor m overactivity and neuroendocrine abberation

Question 10

what is the pathophysiology for overflow incontinence?

Answer 10

blocked urethra

bladder weakness (diabetes, alcohol, nerve impairment)

enlarged prostate

Question 11

What is the most important thing when discerning UI?

Answer 11

ASKING about it during the history

(it can be embarrassing for people to talk about)

ask about fluid intake, frequency, night sx, urge, strain, hesitancy, etc)

Question 12

What pharmacologic factor can cause polyuria and DI?

Answer 12

Lithium

(so make sure you check the pt’s drug list if they have urine issues)

Question 13

What physical exams should be done for UI?

Answer 13

functional assessment

abdominal exam

urogenital exam (pelvic masses, pelvic floor tone, speculum exam, neuro exam, cough stress test)

Question 14

What are some urological tests that can be ordered?

Answer 14

UA with calorimetric reagent test + micro

Urine Cx if positive sx or dip

Post void residual volume

voiding diaries

pad testing

Question 15

how can functional UI be managed?

Answer 15

provide alternative receptacles for urine or planning voids

can try male urinal, commode, condom catheter, reminders to void

Question 16

What is the DIPPERS assessment for things that may cause transient UI?

Answer 16

delerium

infection

pharmaceuticals

psychological morbidity

excessive fluid intake/urine output

restricted mobility

stool impaction

Question 17

What is the conservative management for stress incontinence?

Answer 17

monitor fluid intake

manage constipation

eletrical stimulation

mechanical devices

pelvic floor strengthening

smoking cessation

weight loss

Question 18

what is the management for urge incontinence?

Answer 18

antimuscarinics

intravaginal estrogen

mirabegron

Question 19

what is the treatment for overflow incontinence?

Answer 19

alpha adrenergic antagonists

Question 20

what are some behavioural interventions for UI?

Answer 20

monitor fluids

weight loss

smoking cessation

moderate physical activity

PFMT (pelvic floor exercises/kegals)

Question 21

how does anticholinergics help with UI?

Answer 21

acts directly on detrusor muscle to decrease overactive bladder

Question 22

what are some invasive treatments for UI?

Answer 22

neuromodulation for Urge UI (direct electrical stimulation to modify bladder sensation)

Intravesical BOTOX for urge UI to act at the detrusor presynaptic NMJ (just as effective as oral meds, repeated q9-12 months)

Question 23

UI can complicate which aspects of life?

Answer 23

decrease QOL

interfere with social life, sexual function, relationships

negative impact on psyche and increase depression