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Flashcards in Female Urinary Incontinence Deck (13)
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1

Urinary incontinency definition

involuntary loss of urine which is objectively demonstrable and a hygienic / social problem

2

Types of urinary incontinence

  • genuine stress incontinence
  • urge incontinence
    • detrusor instability/overactive bladder
    • mixed incontinence

3

Characteristics of stress incontinence

  • Leak occurs in spurts
  • Usually occurs with predictable activity (laugh, cough, sneeze, jumping jacks)
  • Leak occurs while intra-abdominal pressure is increased
  • Rarely occurs when supine
  • Usually occurs while upright.

4

Mechanism of stress incontinence

 involuntary loss of urine when bladder pressure exceeds urethral pressure

5

Mechanism of urge incontinence

all caused by overactive detrusor function

6

Characteristics of overactive detrusor

  • Strong urge to void and inability to defer voiding (one pees themselves)
  • Occurs with uncontrollable complete emptying
  • Occurs in any position
  • Associated with “bathroom mapping”

7

Sx associated with overactive detrusor

  • Urgency
  • Nocturia → > 1x after going to bed
  • Frequency → normal < 8 voids in 24 hours

8

Definition of mixed incontinence

combination of both stress incontinence and detrusor instability

9

Types of therapy for overactive bladder

  • estrogen
  • antispasmodics
    • oxybutynin
    • tolterodine
  • anticholinergics
    • trospium
    • solifenacin
    • darifenacin
    • behavioral therapy

10

Mechanism of estrogen as pharm therapy for overactive bladder

  • Local therapy is more effective than oral → for urogenital atrophy → helps improve health of urethra tissue.
  • Usually applied as a cream, as a ring, or as a pill
  • Every night for 3 weeks, then 3 days per week as maintenance therapy

11

Mechanism of antispasmodics as tx for overactice bladder

  • Oxybutynin
    • Smooth muscle relaxant which facilitates bladder storage
    • Metabolite is active and causes more SEs
    • ADRs major concern is dry mouth and constipation
  • Tolterodine
    • Muscarinic receptor antagonist.
    • Similar efficacy to oxybutynin with better tolerance and fewer drop outs

12

Mechanism of anticholinergics as tx for overactice bladder

  • Trospium →  ammonium (quaternary compound that doesn’t cross BBB) nonreceptor selective antimuscarinic. Less SEs than antispasmodics.
  • Solifenacin →  muscarinic receptor (M3) antagonist. More specific, but SEs still bad
  • Darifenacin →  highly selective M3 receptor antagonist. Lots of SEs ? dry mouth and constipation.

13

Characteristics of behavioral treatment of overactive bladder

  • **Kegel contractions
  • teach using instructions +/- perineometer
  • 300 contractions/day logged in exercise tracker
  • patients can produce Kegels as long as anal wink and bulbocavernosis reflexes are intact
  • high success rates
    • Can significantly decrease stress incontinence following pregnancy
    • Can also give patients ability to control urges.