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20 Cards in this Set
- Front
- Back
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592. Risk factors for incontinence?
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a. Age
b. Recurrent UTIs c. Immobility, decreased mental status, dementia, stroke, Parkinson's disease, depression d. DM, CHF e. Multiparity, history prolonged labor f. Pelvic floor dysfunction in women, BPH and prostate cancer in men g. Medications |
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593. Why is age a risk factor for incontinence?
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a. Diminished size of bladder
b. Earlier detrusor contractions c. Postmenopausal genitourinary atrophy |
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594. What medications may cause incontinence?
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a. Diuretics- increase bladder filling, increasing episodes of incontinence
b. Anticholinergic and adrenergics c. Beta blockers d. calcium channel blockers and narcotics e. Alcohol, sedatives, hypnotics |
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595. How do anticholinergic and adrenergic drugs cause incontinence?
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a. By causing urinary retention.
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596. Why may beta blockers cause urinary incontinence?
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a. The diminish sphincter tone
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597. Why may calcium channel blockers and narcotics cause urinary incontinence?
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a. Can decrease detrusor contraction
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598. Why may Alcohol, sedatives, and hypnotics cause urinary incontinence?
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a. Depress mentation.
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599. Most common type of incontinence in elderly and nursing home patients?
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a. Urge incontinence
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600. Causes of urge incontinence?
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a. Multiple causes (often idiopathic), including:
1. Dementia 2. Strokes 3. Severe illness 4. Parkinson's disease |
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601. Mechanism of urge incontinence?
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a. Involuntary and uninhibited detrusor contractions result in involuntary loss of urine.
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602. Clinical features of urge incontinence?
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a. Sudden urge to urinate (e.g., patients are unable to make it to the bathroom)
b. Loss of large volumes of urine with small post-void residual c. Nocturnal wetting |
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603. Management of urge incontinence?
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a. Anticholinergic medications: oxybutynin
b. TCAs: imipramine c. Bladder retraining (behavioral therapy) to help regain control of voiding reflex that has been lost (goal is to increase the amount of time between voiding, “timed toileting”). |
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604. In whom does stress incontinence most commonly occur?
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a. Mostly in women after multiple deliveries of children.
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605. Mechanism of stress incontinence?
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a. Weakness of the pelvic diaphragm leads to loss of bladder support with resultant hypermobility of the bladder neck.
b. This causes the proximal urethra to descend below the pelvic floor so that an increase in the intra-abdominal pressure is transmitted mostly to the bladder (instead of equal transmission to the bladder and urethra). |
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606. Clinical features of stress incontinence?
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a. Involuntary urine loss (only in spurts) during activities that increase intra-abdominal pressure (cough, laugh, sneeze, exercise)
b. Small post-void volume |
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607. Management of stress incontinence?
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a. Kegel exercises to strengthen pelvic floor musculature.
b. Estrogen replacement therapy c. Use of a pessary d. Surgery (urethropexy to elevate vesicourethral junction in return the hypermotile bladder neck to its original position). |
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608. In whom is overflow incontinence?
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a. Diabetic patients and patients with neurologic disorders
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609. Mechanism of overflow incontinence?
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1. Inadequate bladder contraction (due to impaired detrusor contractility)
2. Or 3. A bladder outlet obstruction leads to, urinary retention and subsequent overdistension of the bladder. b. Bladder pressure increases until it exceeds urethral resistance, and urine leakage occurs |
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610. Causes of overflow incontinence?
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a. Neurogenic bladder (diabetic patients, lower motor neuron lesions)
b. Medications c. Obstruction to urine flow (BPH, prostate cancer, urethral strictures, severe constipation with fecal impaction). |
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611. What medications may cause overflow incontinence?
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a. Anticholinergics
b. α- agonists c. Epidural/spinal anesthesia |
