Urinary Incontinence Flashcards
(49 cards)
What is urinary incontinence?
involuntary loss of urine
What is the relationship between urinary incontinence and age?
prevalence increases with age
-prevalence increases to 30-60% in age 65+
What are the medical consequences of urinary incontinence?
urinary tract infections, urosepsis
skin irritation, breakdown, infection
disrupted sleep
falls (rushing, waking up at night)
What are the psychosocial consequences of urinary incontinence?
embarrassment
isolation
depression
DECREASED QOL
Is urinary incontinence well diagnosed?
underdiagnosed
-50-70% do not report symptoms or seek medical advice
-health care providers need to ask
Describe the detrusor muscle.
muscarinic –> contraction (cholinergic)
-ACh = increased contractility
B3 stimulation –> relaxation
-increasing bladder storage capacity
Describe the internal sphincter.
alpha-adrenergic stimulation –> contraction
Which muscles in the bladder are under voluntary control?
external sphincter: voluntary control
pelvic floor muscle: voluntary control
What are the transient/modifiable causes of incontinence?
DIAPPERS
delirium (may be medication related)
infection (may be medication related)
atrophic vaginitis
pharmaceutical
psychological
excessive urine output (may be medication related)
reduced mobility (may be medication related)
stool impaction (may be medication related)
What are the non-modifiable factors associated with urinary incontinence?
increased age
menopause
pregnancy/childbirth
diabetes
stroke
conditions affecting mobility
neurologic injury/disease
What are the modifiable factors associated with urinary incontinence?
certain medications
constipation/impaction
UTI
smoking
caffeine intake
fluid intake
high-impact physical activities
heavy lifting/straining
obesity
What are the types of urinary incontinence?
urgency
stress
mixed
overflow
functional
Which type of urinary incontinence is most common?
stress
Describe urge incontinence.
leakage associated with a sudden, uncontrollable need to void
14% patients with incontinence
overactive bladder (OAB)/detrusor overactivity
-urgency with or without actual incontinence (OAB-wet vs OAB-dry)
-daytime frequency, nocturia
Describe stress incontinence.
leakage with increased abdominal pressure
-ex: exercise, sneezing, coughing
50% incontinence cases
more common in women
Describe mixed incontinence.
both urgency and stress incontinence
32% patients with UI
more common in women
Describe overflow incontinence.
leakage of urine from a full bladder
common with urinary retention
-poor detrusor contractility or
-bladder outlet obstruction (ex: BPH)
-elevated post-void residual (>100ml)
Describe functional incontinence.
impaired ability to reach the toilet
-reduced mobility
-constrictive clothing
-inaccessible toilets or substitutes
-dementia
What are the goals of therapy for urinary incontinence?
relieve distressing urinary symptoms
improve bladder function
prevent complications
avoid treatment side effects
improve quality of life
What is the stepwise approach to treatment of urinary incontinence?
lifestyle modification
behavior modification
medications
minimally invasive procedures, surgery
What are the lifestyle modifications to make to help with urinary incontinence?
decrease weight if BMI > 30 kg/m2
-esp if stress incontinence in middle aged women
decrease alcohol and caffeine intake
restrict fluids in the evening if nocturia
-take diuretics in AM
quit smoking
What are the behavior modifications to make to help with urinary incontinence?
pelvic floor muscle training
-adequate trial x 6-12 weeks
bladder training
-void regularly q1-2h, increase by 15 mins each week
-most effective in combination with drug tx
-urge UI
scheduled/prompted toileting
-q2-3h
What is the place in therapy for pelvic floor muscle training?
1st line for urge, stress, and mixed UI
What are the treatment options for urge incontinence?
antimuscarinics
B3 adrenergic agonists
intravaginal estrogen
-if associated with vaginal atrophy
-usually more for stress or mixed UI
