Week 2 pt 2 Flashcards
(54 cards)
There are 3 main types of urinary incontinence; what are they?
Urge, stress, overflow
List and explain the mnemonic for incontinence causes
DIAPPERS
Delirium is most common in inpt
Infection > Incontinence is not a common sequela of cystitis
Atrophy due to post-menopause can lead to incompetence of urethra
>Treated with topical estrogen
Pharm: diuretics, alpha-agonists, antispasmodic
Psych: either a child who has been abused OR, in an adult, psychomotor retardation and/or despair from severe depression
Excessive Output problem which isn’t compensated
Restricted movement = Can’t get to the bathroom
Stool impaction physically affects bladder filling or drainage
To treat transient urinary incontinence, what is the main thing you need to do?
get to the root of the problem
List 8 characteristics of urge incontinence
Compelling desire to void
Leak before going to bathroom
Occurs supine or upright
Associated with diet
More than 8 voids in 24-hour period
Urgency
Frequency
OAB wet and (OAB dry)
Note: you may have urge incontinence that is from a transient cause
Give the pathogenesis of urge incontinence
1) Detrusor overactivity; increased contraction of detrusor attempting to void the bladder
2) Idiopathic or Secondary to bladder stone/kidney stone or tumor
>Therefore, if onset is abrupt, consider further workup
>Nor should treatment be continued indefinitely without consideration of these insidious causes
What are the main Sx of urge incontinence?
1) Intense urge to void followed by leakage
2) Most common cause of incontinence in the geriatric pt (esp elderly women)
3) Happens day and night
How do you diagnose urge incontinence?
Clinical
Cystometry will show random contractions irrespective of bladder fullness
How do you Tx urge incontinence?
1) Kegel exercises: “Stop the flow”
2) Bladder training
-Scheduled voiding, based on shortest length of duration between
-Lengthened periods using relaxation
weight loss
-Dietary modification
-Constipation tx
-Smoking cessation
List some of the biggest offenders that worsen urge incontinence
1) Coffee (even if decaf)
2) Tea
3) Pop
4) Alcohol
5) Spicy foods
6) Tomato based products
7) Chocolate
8) Non-nutritive sweeteners
List the meds for urge incontinence (only need to know one)
*Oxytrol 1 patch 3.9 mg/day twice a week
*Oxybutynin 5 mg po q 8 hours
*Tolterodine 4 mg po daily
*Oxybutynin ER 10 mg po daily
Trospiuim 20 mg po bid
Gelnique 10% 1 pump to skin daily
Vesicare 5 or 10 mg po daily
Toviaz 4 or 8 mg po daily
*Myrbetriq 25 or 50 mg po daily
Describe the etiologies of stress incontinence
Urethral incompetence; intra-abdominal pressure exceeds urethral closing pressure:
1) Any age woman; most common type in women (young>old)
2) hx multiple vaginal births
3) Male with radical prostatectomy
4) Occurring during the daytime
5) Reg bladder contractions
What are the Sx of stress incontinence?
Instantaneous leak with stress maneuver, like laughing, sneezing/coughing, standing/exercise
How do you Dx stress incontinence?
Clinical:
-Stand with full bladder and relax perineum
-Cough
-Immediate expulsion of urine
Don’t actually make them do that ^
Describe overflow incontinence
1) “Water over the dam”; leaks and do not realize it
-Full bladder
2) Leaks with stressful situations
3) High urinary residual
4) Obstruction vs flaccid bladder causes
How do you Tx stress incontinence?
1) Can try pelvic floor exercises/kegels
2) Pessaries in female patient/w/ w/o cystocele
3) Lifestyle/dietary modification:
-Decrease caffeine, carbonated, alcoholic drinks; and overall fluid intake*
4) Surgery to repair cystocele
-Cyst urethropexy-bladder sling
-Urethral injections (bulking)
1) What causes overflow incontinence? Give 2 examples
2) Is it common?
1) Detrusor underactivity: Idiopathic vs. lower motor neuron problem
-Trauma, MS
2) Least common type
Overflow incontinence:
1) Main Sx?
2) How do you Dx?
1) Nocturnal leakage
2) Cystometry will show no contractions
-Increased post void residual (approx. > 450mL); never completely emptying
-What is normal?
Overflow incontinence:
What are the 2 main treatments? Describe each
1) Cholinergic Agonist: Bethanechol*
-Stimulates parasympathetic nervous system
-This increases bladder muscle tone, causing contractions to initiate urination
2) Augmented voiding
-Suprapubic pressure, double voiding
-Catheter
- = also used for retention
Urethral obstruction→ incontinence
1) What are some etiologies?
2) How do you Dx?
1) Prostate enlargement: BPH, Cancer
-Urethral stricture, bladder neck contracture
2) Clinical vs imaging
-Imaging for physical obstruction: cystourethroscope, retrograde urethrogram, voiding cystourethrogram, US
Urethral obstruction→ incontinence:
What are the Sx?
1) Dribbling incontinence post void
2) Hesitancy
3) Decreased force of stream
4) Straining
5) Overflow incontinence
Urethral obstruction→ incontinence:
What are the main treatments? (based on the 3 main causes)
1) BPH: Alpha antagonists
2) CA: Surgery, radiation
3) Physical obstruction: surgery, catheter
Functional Incontinence: What causes this?
Physical or mental impairment:
1. Totally oblivious to incontinence
2. Physical limitations getting to bathroom
3. Just do not want to make the effort
-cannot recognize the need to go
-cannot locate toilet
-cannot access toilet
Nephrolithiasis/urolithiasis: What is the etiology? Explain
1) Calcium oxalate 85% of the time
2) Can also be calcium phosphate, struvite, uric acid, cystine
3) Inadequate hydration
4) Genetics? Potentially with common Ca2+ stones, but certainly with cystine
Nephrolithiasis/urolithiasis:
Who is it more commonly found in?
1) Obesity, HTN, DM, carotid calcification, CVD, gastric bypass, gout, Crohn’s (don’t memorize)
2) There is a geographic component
Hot climates and high altitude
More often in summer months
