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Urinary Incontinence
Clinical Medicine II
| Question | Answer |
|---|---|
| Involuntary leakage of urine | urine incontinence |
| Who are at risk or who should we ask for UI | women who have had kids, individuals w/ comorbid conditions, >65 |
| Sudden and compelling desire to pass urine that is difficult to defer | urgency |
| Involuntary leakage accompanied by urgency (drops of urine to soaking thru pants) | urge incontinence |
| What are things that can precipitate urge incontinence | running water, hand washing, going out into the cold |
| What is stress incontinence | involuntary leakage w/ effort: exertion, sneezing, coughing |
| What determines immediate and delayed leakage | I: failure of sphincter, D: difficult to stop uninhibited detrusor |
| What is mixed incontinence | involuntary leakage w/ urgency and stress |
| Urgency, frequency, nocturia, w/w/o urge incontinence | overactive bladder (symptom and syndrome) |
| Continuous leakage, usually dribbling of sm amounts of urine | continuous urinary incontinence |
| Complaint of needing to void too often during the day | daytime frequency |
| Waking at night oneor more times to void | nocturia |
| Same as above w/ incontinence | nocturnal enuresis |
| Perception of reduced urine flow, compared to previous performance | slow stream |
| Urine flow which stops and starts on one or more occasions during voiding | intermittent |
| Difficulty in initiating voiding | hesitancy |
| Muscular effort used to initiate, maintain, or improve urinary stream | straining to void |
| Sensation that the bladder is not empty after voiding | incomplete empyting: obstruction? |
| In men, sx associated w/ leakage | post-void dribbling |
| What causes overactive bladder syndrome | role of afferent sensory n. pathway of the bladder, detrusor hyperactivity w/ impaired contractility |
| When does stress leakage occur | an increase in intraabdominal pressure overcomes sphincter closure in the absence of a bladder contraction. MC in younger women |
| Combination of urge and stress incontinenc e | mixed incontinence |
| Mechanisms of mixed incontinence | detrusor overactivity, impared urethral sphincter tone (surgery, birth) |
| Overflow incontinenc e | d/t incomplete bladder emptying |
| Is incomplete emptying common in women | no. |
| What can cause obstruction in women | scarring from previous surgery, pelvic organ prolapse, suprasacral spinal injury |
| Causes of incomplete emptying | detrusor underactivity |
| What is DHIC | detrusor hyperactivity impaired contractility: urgency w/ ↑ postvoid residual vol in absence of obstruction |
| Neurogenic bladder | unspecific term for a dx of areflexia d/t a neruo d/o |
| What is functional incontinence | related to potentially reversible conditions, cognition, mobility, medications |
| Uncommon causes of UI | Vesico-Vaginal fistula (UC or CD), impaired detrusor compliance |
| Causes for sudden onset of incontinence | UTI, neuologic, neoplastic |
| Hy do we check SCa+, glucose, VIt B12 for UI | |
| When do we do a urine cytology | if hematuria and pelvic pain |
| Stress test for UI | have pt cough w/ a pad Instant: stress incontinence, delayed: cough-induced detrusor overactivity, -: less useful |
| When do we do postvoid vol test | women sig pelvic organ prolapse, nero dz’s or recurrent UTI, DM and PN |
| What is adequate emptying | <50 PRV, >200 suggestive of detrusor weakness or obstruction |
| What is the UI test gold standard | Urodynamic Testing Look up |
| Tx of UI | Behavior! diet, fluid intake, bladder training, timed voiding, (voiding diary, ↑ gradually voiding trails) |
| Dx of UI | clinically establish cause (Urge, stress, mixed, incomplete voiding), kegel exercises, |
| Do we practice kegels during voiding | no., during the URGE to urinate |
| Refer when | when you think, is right, |
| What are some medications for UI | urethral bulking agents: collagen, silicone |
| Surgical Tx in women | restore urethral support: midurethral sling support |
| Surgical Tx in men | artificial urinary sphincter |
Created by:
becker15
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