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Urinary incontinence Flashcards

(50 cards)

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1
Q

Nl bladder fx should

A

Store LRG volumes of UA at low pressures

Empty bladder completely

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2
Q

Continence is dependent on

A

Compliant reservoir

Efficent sphincter

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3
Q

Efficent sphincter Req two components

A
  1. Involuntary smooth muscle of bladder neck

2. Voluntary sk muscle of external sphincter

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4
Q

F- RFs of incontinence

A 
Obesity
Age
Multiparity
Vaginal Delivery
Fam Hx
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5
Q

M- RFs of incontinence

A 
Age
Prostate Dz
UTI Hx
Constipation
DM
Neuro Dz
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6
Q

Urinary incontinence classified as

A

Transient - reversible

Established - low GU tract patho or age-related physiology

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7
Q

Transient incontinence causes

A

DIAPPERS

  • delerium
  • infection (symptomatic UTIs)
  • atrophic vaginitis/urethritis
  • Pharm - Rx
  • psychologic factors
  • excess UO
  • restricted mobility
  • stool impaction
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8
Q

MC transient cause in admitted pts - and other -

A

Delirium

-stool impaction

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9
Q

MC transient Rx causes

A 
Diuretics
Anticholinergics
Psychotropics
Opioids
Alpha-blks (F)
Alpha-agonist (M)
CCB
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10
Q

Incontinence established causes

A

Detrusor overactivity (urge Incontinence)

Urethral incompetence
(Stress Incontinence)’

Urethral instruction

Detrusor underactivity (overflow Incontinence)’

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11
Q

Types of urinary Incontinence

A

Total Incontinence
Stress Incontinence
Urge Incontinence
Overflow Incontinence

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12
Q

Total Incontinence is?

A

Urinary loss at all times and in all positions - aka continuous incontinence

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13
Q

Total Incontinence is due to?

A

Anatomic ABNLs

  • Lost sphincter efficiency
  • Fistulas 2/2 pelvic/vag surgery or diverticulitis
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14
Q

TXT Total Incontinence

A

Surgery

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15
Q

Total Incontinence Hx

A
  • Leakage degree
  • Relation to activity
  • Position/fullness of bladder
  • Timing of onset
  • progression
  • PMH/PSH/Rx/OB hx
  • supplements
  • voiding Diary
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16
Q

Total Incontinence PE

A

GU - pelvic exam
GI - rectal exam
Neuro Exam
Bladder stress test

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17
Q

What is a stress test for the bladder?

A

Pt stands and coughs w/ full bladder

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18
Q

Incontinence Labs W/U

A

UA-Cx > UTIs
BUN/creatinine > renal Fx
PSA

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19
Q

Incontinence Special tests?

A 
Post-void residual urine volume
Cystogram
Urodynamic studies (nit routine)
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20
Q

Purpose of Post-void residual urine volume test for Total Incontinence

A

Via urethral cath or U/S a PVR volume <50mL is NL

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21
Q

Purpose of cystogram for Total Incontinence

Study These Flashcards
A

Evaluates fistulas or bladder neck for descent issues

22
Q

Purpose of urodynamic studies is?

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A

Cystometry studies
Uroflow testing
(Not routine)

23
Q

What is stress incontinence?

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A

Instant urine leakage in response to a stress maneuver

24
Q

stress incontinence is aka?

Study These Flashcards
A

Urethral incompetence

25
2nd MC cause if urinary incontinence in older women?
Stress incontinence
26
MC incontinence in men S/P radical prostatectomy?
Stress incontinence
27
Stress incontinence can coexist w/? and is ass/w?
detrusor muscle over activity - Pelvic floor laxity - Poor vesicourethral sphincteric unit
28
Stress incontinence leakage occurs the worse during?
the day
29
Stress incontinence stress test result?
Positive
30
Multiparous women, pelvic surgery and prostate surgery are all ass/w?
- Pelvic floor laxity | - Poor vesicourethral sphincteric unit
31
Stress incontinence TXT?
Kegal exercises lifestyle mod - limit caffeine/fluid intake or weight loss Pessaries or vaginal cones Sling surgery
32
Urge incontinence is
``` Overactive bladder (detrusor over activity) Urinary leakage after intense urge ```
33
2/3 of geriatric incontinence is due to?
Urge incontinence
34
Urge incontinence w. men MC ass/w?
urethral obstruction from BPH
35
Sudden unexplained onset of Urge incontinence reqs?
Cystoscopy or urine cytology to R/O bladder stones/tumor
36
Urge incontinence 1st line TXT?
Bladder training (scheduled voiding while gradually lengthening time between voids w/ relaxation techqniues)
37
Urge incontinence other TXT?
``` Lifestyle modifications (Wgt loss, caffeine reduction) Timed/prompted voiding for cognitively impaired Kegal exercises ```
38
Urge incontinence Rx TXT?
Antimuscarinics 1st (SEs- delirium, dry mouth, retention) -Solifenacin -Oxybutynin -Fesoterodine -Tolterodine 2nd - Antispasmodic (SEs- less dry mouth, Cardiac efx) 3rd - Onabotulinum toxin A - inject detrusor muscle
39
Least common incontinence
Overflow incontinence
40
Overflow incontinence is usually due to?
Idiopathic or Sacral LMN dysfx | Somtimes chronic urinary retention (over-distended bladder)
41
Overflow incontinence S/S
Urinary frequency Nocturia Freq leakages of small volumes
42
Overflow incontinence postvoiding residual urine volume?
>450mL
43
Overflow incontinence TXT
Augmented voiding techniques - double voiding/suprapubic pressure Intermittent or indwelling cath
44
Urethral obstruction is usually due to?
BPH Urethral stricture Bladder neck contacture Prostatic cancer
45
What is a common cause of established urinary incontinence in older men?
Urethral obstruction
46
Urethral obstruction S/S
``` Post-void dribbling Urge incontinence-(2/3 pts coexist detrusor overactive) Overflow incontinence (obstuct > retain > overflow) ```
47
Urethral obstruction TXT
Relieve obstruction - surg decompress (most effective -esp retain/BPH) - intermittent/indewlling cath (non-op UA retain) - A-blks (Terazosin, prazosin, tamulosin)
48
General TXT strategies
``` Kegal exercises Wgt loss Reduce fluids, caffeine, ETOH, Tob cessation no evening fluids TXT constipation TXT pulm Dz (PVT valsalva coughs) Pads/briefs ```
49
Kegel exercise how to
``` squeeze pelvic floor muscles hold 3 seconds/release 3 seconds RPT 10x Each week, add 1 second until 10 seconds each time Work up to 3 sets everyday ```
50
Best tool for evaluating incontinence?
bladder/voiding diary

Urology (7 decks)

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