Urinary Incontinence - Dr. Miller

Question 1

Transient Urinary Incontinence

Answer 1

sudden and less then 6mos

can be reversed

Question 2

chronic Urinary Incontinence 4 types

Answer 2

from stress, urge, mixed, overflow

Question 3

Stress UI

Answer 3

coughing, sneezing, Physical activity (more in women)

Question 4

Urge UI

Answer 4

sudden need to or desire to void peeing

—-> causing leakage

Question 5

Mixed UI

Answer 5

mix stress and urgency UI

Question 6

Overflow UI

Answer 6

urinary retention from detrusor underactivity or outflow obstruction (BPH) —-> causing leakage

Question 7

Functional UI

Answer 7

from cognitive limits or physical limits –> pee themselves

Question 8

risks of UI

Answer 8

1. age
2. obesity
3. pulmonary diseases, smoking
4. DM
5. many vaginal deliveries
6. BPH
7. medications
8. neural problems

Question 9

what keeps urine from leaking

Answer 9

pelvic floor muscles
external sphincter
urethral P

Question 10

during stress or cough what happens

Answer 10

Hammock hypothesis = urethra is compresses on the endopelvic fascia —-> stops pee

Question 11

UI what muscle contracts more

Answer 11

Detrusor Muscle over active

Question 12

overflow UI what happens

Answer 12

bladder gets so full it leaks out
= weak muscle
= blockage (BHP)
= DM

Question 13

UI SX

Answer 13

=  amout and type fluid intake
= urgency
= can they feel full bladder
= unable to empty 
= pain
= drug intake

Question 14

UI Physical assessment

Answer 14

= BMI
= mental status
= bladder location palpation
= Urigenital examination
= CVA tenderness 
= rectal tone (innervation)
= cough stress test (
= Prostate exam

Question 15

testing for UI

Answer 15

1. UA + microscopy (rule out UTI, glucose, protein, cr)
2. • dip stick or sx—-> Urine culture
3. Post void residual volume (PVR)= how much bladder emptied (abnormal >200mL)
4. voiding diaries
5. pad testing

Question 16

urodynamic studies do what

Answer 16

if dx is uncertain after evaluation**
= measures P in bladder and of muscles and nerves and all that
= for deciding if you should do an invasive irreversible tx

Question 17

rule out reversible causes of UI HOW

Answer 17

DIPPERS

1. Delirium
2. Infection (acute UTI)
3. Pharm : Drugs
4. Psychological morbidity
5. Excess fluid intake
6. Restricted mobility
7. Stool impaction (constipation)

Question 18

UI TX

Answer 18

STRESS : drink water, manage C, weight loss, Pelvic Floor Muscle strengthening —-> Kegel exercise)**
URGE : medicines to lower nerves (antimuscar, estrogen cream)
OVERFLOW: a-adrenergic antagonists** —–> decrease prostate size

Question 19

behavior changes for UI

Answer 19

carbonated drinks, caffeine, alcohol limited

weight loss + Pelvic floor strength for stress UI

stop smoking , regular exercise

Question 20

stress UI meds

Answer 20

none

Question 21

urge UI meds

Answer 21

1. vaginal estrogen when with urogenital atrophy and LUTS
2. Anticholinergic to decrease detrusor overactivity (OXYBUTYNIN = Antimuscarinic B2)*****
3. botox

Question 22

complications of UI

Answer 22

sexual dysfunction, poor sleep, , social isolation