Repro - 1-25 Incontinence

Front 1

http://www.auanet.org/content/education-and-meetings/med-stu-curriculum.cfm

Back 1

has some questions on it. check it out she might take practice questions from here (she wrote this site)

Front 2

Is incontinence a normal part of aging?

Back 2

no

Front 3

Definition

Back 3

leakage of urine THAT INTERFERES WITH QUALITY OF LIFE OR HEALTH.

it is leakage of any amount of urine. doesn't matter how many pads you wear.

Front 4

most common reason in med to get it

Back 4

after surgery for prostate CA or BPH

Front 5

External sphincter relationship with passive continence

Back 5

not involved.

Front 6

Symp innervation of lower urinary tract

Back 6

Hypogastric nerves

T10-L2

Front 7

Parasymp inn of lower urinary tract

Back 7

pelvic nerves

S2-4

Front 8

Somatic inn of lower urinary tract

Back 8

Pudendal nerves

Includes external urethral sphincter and muscles of the pelvic floor

Front 9

Innervation at bladder neck and top of urethra

Back 9

hypogastric nerve.

Symp lets you hold urine in.
Para lets you urinate. (beta receptors)

Front 10

Bladder dysfunction causes of incontinence

Back 10

Urge incontinence
Either due to detrusor overactivty (neurogenic or nonneurogenic origin) or poor compliance (gradual rise in pressure)

Overflow incontinence - incomplete emptying

Front 11

Urethral dysfunction causes of incontinence

Back 11

leakage with activity.

Stress incontinence due to anatomic issues (mobility of bladder neck) or intrinsic sphincter deficiency

Front 12

DIAPPERS

Back 12

reversible causes of incontinence

Delirium
Infection
Atrophic vaginits
Pharmacologic (e.g. narcotics)
Psychological
Excessive urine prod
Restricted mobility - can't get to bathroom
Stool impaction

Front 13

Constant incontinence causes

Back 13

congenital ectopic fistula

iatrogenic vesicovaginal fistula

Front 14

why smoking is a risk factor

Back 14

more coughing, more damage to pelvic floor.

Front 15

is low fluid intake a risk factor?

Back 15

yes - high [] urine is bad.

Front 16

estrogen depletion can cause...

Back 16

atrophic vaginitis.

Front 17

Types of incontinence

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stress, urge, overflow, mixed

Front 18

Stress incontinence pts are...

Back 18

rarely wet at night.

leakage with coughing, laughing, sneezing, etc.

Front 19

Stress incontinence due to...

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abdominal pressure poorly transmitted to proximal urethra.
loss of support from pelvic floor muscles.

or intrinsic sphincter deficiency - due to surgery, alpha blockers, hormones.

Front 20

Urge incontinence

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can be triggered with water cues.

there is a demand to go immediately and you have no choice.

bladder pressure gets really high and exceeds sphincter pressure.

Due to detrusor overactivity or hyperreflexia.

Front 21

CMG (cystometrogram) in overactive bladder

Back 21

high pressures relieved when urination begins.

Front 22

"overactive bladder"

Back 22

created by drug companies - not associated with any leakage.

Front 23

CMG in poor compliance bladder

Back 23

the CMG just linearly increases

Front 24

Detrusor underactivity

Back 24

can lead to incontinence

Front 25

Causes of extreme bladder volumes

Back 25

rare in women - prolapse or post suspension

men - prostate disease or urethral stricture

Front 26

when to consider urethral strictures

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young pts.

due to STIs or trauma to urethra (often falling on bar of bicycle)

Front 27

Dysfunctional eliminators

Back 27

they dont relax pelvic floor when they void so bladder has to squeeze very very hard but tires out with time.

bowel movements every 7-12 days

Front 28

provacative stress test

Back 28

checking to see if the pt leaks with an increase in abdominal pressure.

Front 29

when to do urodynamics

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pts who don't respond to medical therapy.

it is to assess bladder storage (overactivity and urge), outlet (abnormal bladder neck and stress) and emptying (overflow).

Front 30

when to do pad test

Back 30

when history doesn't match the physical (e.g. bad history but no leaking on provocation)

Front 31

Tx of urge incontinence - ways to deal with it

Back 31

absorbent products
external collection devices for males (condom with a bag on the end)
penile clamps
indwelling catheters - which exacerbates the bladder problem bc the bladder wants to contract to get the foreign object out)

Front 32

Conservative ways of treating urge incontinence

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timed voiding is the best thing.
change fluid intake
pelvic floor exercises...

Front 33

Anticholinergic SEs

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dry mouth
flushing
constipation (and stool impaction is a cause of urge incontinence so this can make things worse)
urinary retention

CONTRAIND IN NARROW ANGLE GLAUCOMA (most pts have open angle)

Front 34

rx of poor compliance

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complete bladder emptying with clean intermittent cath or indwelling cath

anticholinergics

alpha antag.

Front 35

Rx of stress incontinence

Back 35

pelvic floor exercises
alpha agonists
estrogen
tricyclic antidepressants

Front 36

Rx of urge incontinence - surgical

Back 36

treat the bladder outlet obstruction (e.g. TURP)
botulinum toxin
nerve stim

Front 37

Tx of overflow - surgical

Back 37

releive the obstruction

empty bladder (CIC or timed voiding)

Front 38

PV sling

Back 38

pulls bladder neck up - good for anatomy stress urge incontinence

an alternative to this is injecting collagen

Front 39

Follow-up in these pts

Back 39

check post-void residual if previously abnormal.

anticholinergics

determine response to treatment.