Female Urinary Incontinence Flashcards Preview

Life Cycles: Unit 1 > Female Urinary Incontinence > Flashcards

Flashcards in Female Urinary Incontinence Deck (13)
Loading flashcards...

Urinary incontinency definition

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


Types of urinary incontinence

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


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.


Mechanism of stress incontinence

 involuntary loss of urine when bladder pressure exceeds urethral pressure


Mechanism of urge incontinence

all caused by overactive detrusor function


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”


Sx associated with overactive detrusor

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


Definition of mixed incontinence

combination of both stress incontinence and detrusor instability


Types of therapy for overactive bladder

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


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


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


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.


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.