Urinary incontinence Notes

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Urinary incontinence

NOTES NOTES URINARY INCONTINENCE GENERALLY, WHAT IS IT? PATHOLOGY & CAUSES ▪ Inability to maintain micturition control → involuntary urine leakage ▪ Chronic urinary incontinence: important geriatric issue, affecting personal hygiene, social life TYPES ▪ Urge, stress, mixed (combination of stress, urge), overflow, functional SIGNS & SYMPTOMS ▪ Involuntary urine leakage DIAGNOSIS OTHER DIAGNOSTICS ▪ History (e.g. voiding diary) ▪ Physical examination; urine leakage easily established ▪ Urodynamic studies TREATMENT MEDICATIONS ▪ See individual disorders SURGERY ▪ See individual disorders OTHER INTERVENTIONS ▪ Behavioral therapy, lifestyle changes, catheterization, incontinence undergarments DIAGNOSTIC IMAGING Abdominal ultrasound LAB RESULTS ▪ Urinalysis ▪ Renal function Figure 121.1 Illustration of somebody with urinary incontinence. This condition can negatively affects one’s personal hygiene and social life. 858 OSMOSIS.ORG
Chapter 121 Urinary Incontinence OVERFLOW INCONTINENCE osms.it/overflow-incontinence PATHOLOGY & CAUSES ▪ Urinary retention → bladder pressure increases, exceeds urethral resistance CAUSES Urinary flow blockage ▪ Benign prostatic hypertrophy, prostate cancer, urethral strictures, severe constipation with fecal impaction, cystocele, prolapsed uterus Ineffective detrusor muscle ▪ Disorders affecting autonomic innervation of bladder (e.g. diabetes mellitus, spinal cord injury, cauda equina syndrome, spinal cord anomalies), anticholinergics SIGNS & SYMPTOMS ▪ Frequent loss of small amount of urine; hesitancy; weak/intermittent urinary stream DIAGNOSIS DIAGNOSTIC IMAGING Abdominal ultrasound LAB RESULTS ▪ Urinalysis ▪ Renal function OTHER DIAGNOSTICS ▪ History (e.g. voiding diary) ▪ Urine leakage easily established ▪ Urodynamic studies TREATMENT MEDICATIONS ▪ Cholinergic agents (e.g. bethanechol, increases bladder muscle tone), alpha blockers (e.g. prazosin, tamsulosin, relaxes smooth muscle in bladder neck) SURGERY ▪ Anterior colporrhaphy/colposuspension OTHER INTERVENTIONS ▪ Intermittent self-catheterization OSMOSIS.ORG 859
Figure 121.2 Illustration of overflow incontinence’s causes and possible avenues to treatment. STRESS INCONTINENCE osms.it/stress-incontinence PATHOLOGY & CAUSES DIAGNOSIS ▪ Pelvic floor laxity → urethra loses support → increase in intra-abdominal pressure → overwhelms sphincter muscles DIAGNOSTIC IMAGING RISK FACTORS LAB RESULTS ▪ Most prevalent in individuals who are biologically female, < 70 years old ▪ Menopause, multiparity/childbirth-related trauma, pressure on bladder during pregnancy, obesity, urologic/retropubic surgery SIGNS & SYMPTOMS ▪ Spurts of urine when intra-abdominal pressure increases (e.g. sneeze, cough, laugh, exercise) 860 OSMOSIS.ORG Abdominal ultrasound ▪ Urinalysis ▪ Renal function OTHER DIAGNOSTICS ▪ History (e.g. voiding diary) ▪ Urine leakage easily established ▪ Urodynamic studies TREATMENT MEDICATIONS ▪ Estrogen replacement therapy (only for stress incontinence caused by menopause)
Chapter 121 Urinary Incontinence OTHER INTERVENTIONS ▪ Lifestyle changes (e.g. weight loss) ▪ Kegel exercises to strengthen external sphincter, pessaries, electrical stimulation ▪ Sling procedures Figure 121.3 Illustration of stress incontinence’s causes and possible avenues to treatment. URGE INCONTINENCE osms.it/urge-incontinence PATHOLOGY & CAUSES ▪ Overactive bladder: uninhibited detrusor muscle contracts randomly CAUSES ▪ Urinary tract infections (UTIs) ▪ Central nervous system (CNS) disorders: stroke, Parkinson’s disease (PD), multiple sclerosis (MS) RISK FACTORS ▪ Most prevalent in elderly individuals SIGNS & SYMPTOMS ▪ Sudden/great urine leakage, strong/ immediate urge to void; frequency; nocturnal wetting DIAGNOSIS DIAGNOSTIC IMAGING Abdominal ultrasound LAB RESULTS ▪ Urinalysis ▪ Renal function OSMOSIS.ORG 861
OTHER DIAGNOSTICS ▪ History (e.g. voiding diary) ▪ Urine leakage easily established ▪ Urodynamic studies TREATMENT MEDICATIONS ▪ Anticholinergic agents → inhibit detrusor overactivity by blocking muscarinic receptors ▪ Tricyclic antidepressants (TCAs) → anticholinergic properties 862 OSMOSIS.ORG SURGERY ▪ Injections with botulinum toxin → prevent acetylcholine release, decrease detrusor muscle activity OTHER INTERVENTIONS ▪ Lifestyle changes (e.g. avoid alcohol, diuretics) ▪ Kegel exercises ▪ Bladder/toilet training ▫ Relaxation techniques ▪ Sling procedures

Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Urinary incontinence essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Urinary incontinence by visiting the associated Learn Page.