Flashcards in Urology: Incontinence Deck (147)
What is frequency?
The need to void very often, typically affecting QOL (>8x / day)
What is nocturia?
Need to void during night, typically affecting QOL (>2x)
What is urgency?
Sensation to void that is so strong that fear of urine loss is imminent
What is incontinence?
Involuntary loss of any amount of urine
What is the prevalence of UI in community-dwelling older adults?
What is prevalence of UI in residents of long-term-care institutions?
Does prevalence of UI increase with age?
Does UI affect more women or men?
-More women than men (2:1) until 80, then it's 1:1
How many people with UI seek medical attention?
Fewer than half
What are 2 categories of impact of UI on older adults?
2. Cost: Over 26 billion annually
What are the morbidities associated with UI?
-Cellulitis, pressure ulcers, UTIs
-Sleep deprivation, falls with fractures (fall while going to bathroom at night), sexual dysfunction
-Depression, social withdrawal, impaired quality of life
What is required for continence?
-Manual Dexterity: To undress, use cane, ect.
-Motivation: Psychiatric spectrum
-Control of bladder contraction & urethral closure mechanisms
In normal micturiction, what is the bladder under control of?
The detrusor muscle
What does the detrusor muscle contract via?
PS nerves (S2-S4)
What does the proximal urethral smooth muscle contract via?
Sympathetic stimulation: T11-L2
What does the distal urethral striated muscle contract via?
Cholinergic somatic stimulation: S2-S4
In women, what does musculofascia do?
Supports and compresses the urethra when abdominal pressure increases
What is urine storage under control of and how does this function?
-Inhibits detrusor contraction
-Increases sphincter contraction
What is voiding under control of and how does this function?
-Induces detrusor contraction
-Induces sphincter relaxation
As the bladder fills, what does sympathetic nerve activity do?
Increases the outlet resistance and inhibits detrusor contraction
When does somatic nerve activity increase?
As the bladder fills to tighten the pelvic floor
What changes occur with the aging process which can contribute to urinary incontinence?
-Inability to postpone voiding
-Increased night time urine volume
What are some age related lower urinary tract changes?
-Benign prostatic hypertrophy
-Urine output shifted later in the day
-Atrophic vaginitis and urethritis
-(Modest) increase postvoid residual (PVR)
-Decreased ability to postpone voiding
-Decreased total bladder capacity
-Decreased detrusor contractility
What are 3 categories of factors contributing to or causing UI in older persons?
1. Comorbid disease
3. Function and environment
What are some examples of comorbid disease that can contribute to or cause UI in older persons?
- Diabetes: Peripheral neuopathy
- Congestive heart failure: Increased noctural peeing due to edema
- Degenerative joint disease
- Sleep apnea
- Severe constipation: Mega-colon...functional bladder capacity is decreased
What are some examples of neurological/psychiatric conditions that can contribute to UI in older persons?
-Normal pressure hydrocephalus
-Depression: Lack of motivation
WHat are some examples of function and environment that can contribute to or cause UI in older persons?
-Impaired cognition: Recognize the need to urinate and what to do
-Lack of caregivers: Maybe need nighttime assistance?
What are come medications that can cause or worsen UI?
-Calcium-channel blockers: Peripheral edema goes intravascularly
-Loop diuretics: Increased urine output
What are 3 categories of causes of nocturia?
1. Noctural polyuria (normal output >35% of total 24 hour output- 1/3 of normal daily output is at night)
2. Sleep Disturbance
3. Lower urinary tract