Urinary Incontinence

Question 1

Urinary incontinence (UI) is the complaint of _________________

Answer 1

involuntary leakage of urine

Question 2

There are a number of types of urinary incontinence:
1.
2.
3.
4.

Answer 2

1) Stress 2) Urge 3) Overflow 4) Functional

Question 3

Impairment in _____ function leads to incontinence

Answer 3

urethral

Question 4

Under normal conditions urethral pressure ______ bladder pressure resulting in urine remaining in the bladder

Answer 4

exceeds

Question 5

Some symptoms of urinary incontinence include:
1.
2.
3.

Answer 5

1. Voiding (small or large volumes)
2. Nocturia
3. Dribbling

unable to hold voiding, urine loss with abdominal pressure, dyspareunia (painful intercourse), dysuria

Question 6

Non-modifable risk factors for urinary incontinence:
1.
2.

Answer 6

Female gender, Elderly,

Question 7

Modifiable risk factors:
1.
2.
3.
4.

Answer 7

1. Caffeine intake
2. BPH in men
3. Obesity
4. Medications

Smoking, Bowel problems, fluid intake, limited physical activity, lower urinary tract conditions, restricted mobility

Question 8

What is the most common form of UI in women?

Answer 8

Stress incontinence

Question 9

Urine leakage in stress incontinence is the result of __________ causing pressure inside the bladder to overcome the ability of the compromised urethral sphincter to close the urethra

Answer 9

increased intra-abdominal pressure (cough, sneeze, laugh)

Question 10

__________ involves leakage of moderate to large amounts of urine due to inability to delay voiding when an urge is perceived

Answer 10

Urge incontinence

Question 11

__________ is a syndrome that includes urgency and can lead to urge incontinence

Answer 11

Overactive bladder

Question 12

Chronic retention of urine often involves leakage of urine which leads to __________ incontinence when the amount of urine retained produces pressure beyond the sphincter or obstruction pressure.

Question 13

Overflow incontinence presents with ________ (the type of frequency)

Answer 13

dribbling

Question 14

_______________ is the loss of urine caused by the inability to get to or use the toilet, and does not involve changes in the lower urinary tract

Answer 14

Functional incontinence

Question 15

Causes of functional incontinence
1.
2.
3.

Answer 15

physical constraints (ex restricted mobility) cognitive factors (dementia, depression) and environmental barriers (access to toilet, positioning)

Question 16

Examples of drug related causes
1.
2.
3.
4.
5.

Answer 16

1. Antihistamines
2. Anticholinergics
3. Sedatives
4. Narcotics
5. Cholinergics

Muscle relaxants, caffeine, ethanol, etc

Question 17

First line management involves _______ and ________

Answer 17

behavioural therapy lifestyle changes

Question 18

Third line treatment:

Answer 18

Botox

Question 19

First line treatment for stress incontinence

Answer 19

1. pelvic muscle exercises

biofeedback, exercise/weight loss if overweight, pessaries, surgical intervention

Question 20

The following medications have low evidence for treatment in stress incontinence

Answer 20

vaginal estrogen & duloxetine

Question 21

First line treatment for urge incontinence

Answer 21

Behavioural therapy
Bladder retraining
Scheduled toileting
Pelvic muscle exercise

Question 22

_____________ are considered second-line treatment for urge incontinence when nonpharmacologic options fail to provide adequate symptomatic relief

Answer 22

antimuscarinics and beta3 agonist mirabegron

Question 23

Treatment for overflow due to obstruction

Answer 23

alpha antagonists or surgery

Question 24

Treatment for overflow due to detrusor under activity

Answer 24

catheterization, diapers and reassessing medication causes

Question 25

Treatment of urinary incontinence during pregnancy involves ______________

Answer 25

pelvic floor rehabilitation

Question 26

Common side effects of the anticholinergic medications (Oxybutinin, Tolterodine, Darfenacin, Solfenacin, Trospium, Fesoterodine)

Answer 26

Blurred Vision Delirium Constipation (++ common) Sedation (++ common) Urinary retention Dry mouth

Question 27

Anticholinergics should be avoided in patients with 1. 2. 3.

Answer 27

1. Urinary/gastric retention 2. narrow-angle glaucoma 3. cardiac patients

Question 28

These two anticholinergics DO NOT cross the BBB and may be better tolerated in the elderly 1. 2.

Answer 28

1. Tolterodine 2. Trospium

Question 29

The most common adverse effects of mirabegron include: 1. 2. 3.

Answer 29

Hypertension Nasopharyngitis Urinary tract infections Headaches

Question 30

Avoid ________ in sever, uncontrolled hypertension

Answer 30

Mirabegron (also dont crush/chew)

Question 31

TCA's may be used in patients with concomitant ____ or ____

Answer 31

depression or neuropathy

Question 32

If TCA are required in elderly, consider _____ and _____ due to lower risk of anticholinergic s/e

Answer 32

notriptyline and desipramine

Question 33

most common type of incontinence in men?

Answer 33

overflow

Question 34

The following anticholinergic is not metabolized by the CYP450 system

Answer 34

Torspium