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Flashcards in urinary incontinenc Deck (30)
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1
Q

incontinence

A

involuntary loss of urin

2
Q

what is normal physiology of urine release?

A

normally, sympathetic tone closes the bladder neck and increases pelvic floor tone–> during micturition, parasympathetic tone increases, allowing bladder neck relaxation

3
Q

what are the types of urinary incontinence?

A

stress, urge, and overflow

4
Q

what is stress incontinence?

A

urine leakage due to increased intra-abdominal pressure

*rare in men

5
Q

PP of stress?

A

increased intra-abdominal pressure > urethral resistance to urine flow

laxity of pelvic floor muscles; childbirth, surgery, postmenopausal estrogen loss, post-prostatectomy

6
Q

s/sx of stress incontinence

A

increased intra-abdominal pressure from sneezing, coughing, laughing leads to urine leakage

*worse when upright

7
Q

tx of stress incontinence?

A

pelvic floor exercises (87% improvement)

8
Q

medications for stress?

A

alpha agonists: midodrine and pseudophedrine

estrogents: cream or estradiol-impregnated vaginal ring

9
Q

what is the moa of AA?

A

increases urethral outlet resistance–> including artificial sphincter

10
Q

what is the surgical tx benefit for stress?

A

increases urethral outlet resistance, including artificial sphincter

11
Q

what are anti-incontinence devices?

A

vag cones that help stregthen the pelvic floor muscles

12
Q

urge incontinence?

A

urine leakage accompanied or proceeded by urge

13
Q

PP of urge I

A
  • Detrusor muscle overactivity–> involuntary contraction

- overactive bladder- detrusor muscle stimulated by muscarinic acetylcholine receptors

14
Q

s/sx of urge incontinence?

A

urgency, frequency, small volume voids, nocturia

15
Q

tx of urge (non-pharmaceutical)

A

bladder training- can lead to a 75% improvemtn

  • timed frequent voiding, decreased fluid intake
16
Q

pharmaceutical tx for urge?

A

1) anticholinergics
2) TCA
3) Mirabegron

17
Q

what is the first line medical tx for urge incontinence?

A

anticholinergics

oxybutynin: antispasmodic and anticholinergic
tolterodine

18
Q

what is the MOA of anticholinergics?

A

blocks cholinergic receptors in the bladder, which increases bladder capacity and the volume threshold for initiating involuntary contraction

19
Q

what are the side effects of anticholinergics?

A

dry mouth, constipation, dry eyes, blurred vision, increased heart rate

20
Q

how to TCA work in urge incontinence?

A

central and peripheral anticholinergic effect and aa agonist–> bladder muscle relaxation, increases bladder outlet resistance, antispasmodic effect on detrusor muscle and increased urethral sphincter tone

21
Q

what is mirabegron?

A

B3 agonist: bladder relaxant

22
Q

what are surgerical tx for urge incontinence?

A

injection of botox, bladder augmentation

23
Q

what pt education can you give someone with urge incontinence regarding their diet?

A

avoid spicy foods, citrus fruits, chocolate, caffeine

24
Q

what is overflow incontinence?

A

urinary retention: incomplete bladder emptying

25
Q

PP of overflow

A

decreased detrusor muscle activity- atony

“underactive bladder” due to DM, MS, autonomic dysfxn, spinal injury

-Bladder outlet obstruction–> BPH

26
Q

s/sx of overflow?

A

small volume voids, frequency, dribbling

increased post-void residual > 200 ml

27
Q

first line tx of overflow?

A

intermittent or indwelling catheter

28
Q

what meds can be used to tx overflow?

A

1) cholinergics: bethanechol

2) BPH: alpha 1 blockers: tamulosin

29
Q

how does bethanechol work?

A

increases detrusor muscle activity

30
Q

how does tamsulosin work?

A

relaxes the smooth muscle of the prostate and bladder neck, which helps decrease urethral resistance and obstruction