Objectives

1- Define and classify different types of UI

2- identify risk factors and screening options

3- Compare and predict tx for different types of

UI

4- Asses clinical approach to diagnosing and

treating cases of UI

Urinary Incontinence

Urinary Incontinence Red Flags: do more workup in these - Q-tip Test:

Definition : Involuntary or pts Questions to Ask: - helpful in females to diagnoses for
uncontrolled leakage of urine that - Rapid onset - Any problems with badder control? Stress urinary Incontinence
causes a social or hygienic problem - Pelvic Pain Y/N - Goes thru the urethra, measure the
Demographics: - Hematuria - Problems making it to the bathroom angle of Q-tip by making the pt
- ↑’s with age on time? cough or squeeze and evaluate for
- 30% women> 65 Aging and Incontinence - Ever leak urine? leakage and angle of change
- 15-20% men>65 (#’s double in long- A. Decreased: Questionnaire: 3IQ- distinguish urge - If change is more than 30º, pt is at ↑
term care centers) - Bladder contractility & capacity: incontinence from stress risk for stress UI
- Impairs quality of life doesn’t have functial capacity to Incontinence. During the last 3 - Why is not necessary? Bc you can
- 80% cases cured or improved with respond to distension as it fills months, have you get it from hx
tx options - Attentuated striated muscles - Leaked urine (Y/N) Managements and treatments:
Bladder (sphincters become weaker - Did you leak urine when doing these Behavioral, Pharmalogical, and
- detrusor muscle * Uretheral closure pressure (female) activities…(check all that apply) surgical (chart more details, refer to
- External & Internal sphincter - Vaginal Mucosal Activity (atrophy of - Did you leak urine most often when pg 23)
- Normal capacity 300-600ml vagina, dryness) (check 1 that applies) →tells us
- First urge to void 150-300ml B. Increased which one is predominant type Stratergies for managing UI:
- In obstructive processes, urine is - Uninhibited bladder contractions: - Increase our awareness of amount,
constantly being retained and this irritibility of bladder or OAB (due to Cause of UI: DIAPPERS timing of all fluid intake
can lead to increased bladder aging or ANS dysfx) - D: Delirium - Reduce amount/timing of fluid
retention capacity (~1200mL) - Post Voidal Residual: around 200cc, - I: infection intake
- CNS controls via Pons (facilitates) if more than 300 cc, evaluate by - A: Atrophic vaginitis or Urethritis - Avoid bladder stimulants (caffeine)
and cerebral cortex (inhibits) having pt complelety empty bladder - P: Pharmaceuticals - Avoid taking diuretics after 4pm
and use US scan to see how much - P: Psychological Disorders - Reduce physical barriers to toilet
Classification residual left - E: endocrine disorders (use bedside coomode)
- Transient (<6 months): reversible, ↪Normal residual of urine that is (uncontrolled diabetes, DI (frequent - Avoid constipation
underlying cause (UTI, injury to housed in bladder after urinating (can urination) - Void regularly 5-8 times a day
muscles, Surgery, birth) be picked up by Ultrasound) - R: restricted mobility - Perform all pelvic floor excercise
- Chronic: Differentiated into types - Prostate Hypertrophy (male) - S: stool impaction (in rectal area - Stop smoking
(table), can still be reversible messing ANS and sphincter control) - Artificial Urinary sphincter Post Op:
Types of UTI: look at the table Video:https://www.youtube.com/ (another mnemonic is TOILETED- cuff over the proximal urethra (in
watch?v=J2AgZE5kTUU check image) males due to weak sphincter
Risk Factors: Screening muscles)
- Obesity - History and physical Exam Medications that may cause - A pessary: for females adds pressure
- Functional Impairments - Questionnaires Incontinence: against proximal urethra
- Dementia - Diagnostics: - Diuretics - Adult diapers
- Medications • UA (ALWAYS): 1st time evaluation - Caffiene
- Parity: vaginal deliveries in urine incontinence do culture to - Anticholinergics- antihistamines:
- High Impact Excercise check for infections direct effect with detrussor
• Post- Voidal Residual (PVR) - Antipsychotics, antidepressants
• Bladder Diary - seditives/ hypnotics
• Urodynamics (rarely needed) - Alcohol
Best Practice: - Narcotics
- for initial workup: Do NOT perform - Alpha-adrenergic agonists/
cytoscopy urodynamics or antagonists
diagnostic renal and bladder - Calcium Channel Blockers: bc of SMC
ultrasounds of an Uncomplicated relaxation affect ability to control
OAB patient (Unless Red Flags sphincters
present)

Types of Urinary Incontinence

Stress Urge Mixed Overflow Functional

- Most common
- Females > Males
Causes - laugh, cough, - Detrusor - combination of - Urinary Retention - Toileting
sneeze Overactivity Stress and - incontinence with barrier:
- Exertional (uninhibited Urge incomplete bladder cognition,
activity contractions) Incontinence emptying fraility, etc
- Inc in pressure in - Overactive - Incontinence
abdomen that Bladder (OAB) with impaired
pushes down on a - Bladder outlet physical and/
bladder obstruction or or cognitive
- Decrease control irritation function
of sphincter (infection,
- associated with tumor)
multiple births - Cant get to the
- Damage to the bathroom fast
pelvic floor enough
supports
- Sphincter Failure
(internal and/or
External)

Treatment - Kegel - Kegel - alpha-adrenergic - Behavioral

(check image on - behavioral - Behavioral antagonists (men): interventions
pg 23) intervention interventions: Flomax (prompted
- alpha-adrenergic Bladder training - Bladder training, voiding, habit
agonist are not - Antimuscarinic double voiding training)
approved and Beta 3 - Intermittent - Environmental
- Topical estrogen adrenergic catherization manipulation
- periuretheral drugs - Indwelling including use
injections catherization in of urinal or
- Surgery selected patients bedside
in whom risks and commands,
discomforts of safe lit path to
urinary retention bathroom
- Outweigh risks of a - Incontinence
chronic indwelling undergarments
catheter and pads