Urinary Incontinence

Question 1

Describe the sphincters and nervous systems involved in micturition

Answer 1

• internal sphincter: involuntary
• external sphincter: voluntary
• autonomic NS: sympathetic T10-L3 release norepi to relax bladder, parasympathetic S2-S4 release Ach to contract detrusor muscle
• somatic NS: motor neurons from S2-S4 supply external urethral sphincter

Question 2

Describe the detrusor muscle and its actions/functions

Answer 2

• smooth muscle
• contracts & pushes urine out of the bladder (voiding phase)
• relaxed & allows bladder to fill (storage phase)

Question 3

Describe the etiology of urinary incontinence

Answer 3

Question 4

Describe the etiology & RF for stress urinary incontinence (SUI)

Answer 4

Question 5

Describe the presentation of stress UI

Answer 5

Question 6

Describe the treatment for stress UI

Answer 6

Question 7

Describe the etiology of urgency urinary incontinence (UUI)

Answer 7

Question 8

Describe the presentation of urgency UI

Answer 8

Question 9

Describe the diagnosis of UUI/OAB

Answer 9

Question 10

Describe the initial management of urgency UI

Answer 10

Question 11

Describe the pharm for urgency UI

Answer 11

Question 12

List some bladder irritants

Answer 12

Question 13

Describe the etiology of overactive bladder syndrome

Answer 13

Question 14

Describe the presentation of overactive bladder syndrome

Answer 14

Question 15

Describe the etiology of mixed UI

Answer 15

Question 16

Describe the etiology of overflow incontinence

Answer 16

Question 17

Describe the diagnosis of overflow incontinence

Answer 17

Question 18

Describe the treatment for overflow incontinence

Answer 18

Question 19

Describe the etiology of neuropathic incontinence

Answer 19

Question 20

Describe the presentation of neuropathic incontinence at the different levels of injury/lesion

Answer 20

Question 21

List some health complications of urinary incontinence

Answer 21

• risk of death in nursing home
• MH and social concerns
• incontinence associated dermatitis (contact)
• tricky balance between incontinence and retention

Question 22

what are some side effects of anticholinergics?

Answer 22

dry mouth, dry eyes, constipation, exacerbation of dementia/cog impairment

Question 23

what physiologic effect does mirabegron (beta agonist) have on the urinary tract?

Answer 23

relaxes the bladder/detrusor muscle

Question 24

what PVR would you expect in a patient with overflow incontinence?

Answer 24

> 200 ml

Question 25

what PVR would you expect in a patient with urge incontinence?

Answer 25

normal <50 ml

Question 26

a male pt has OI secondary to BPH, what are some pharm options?

Answer 26

Finasteride (5A reductase inhib), alpha blockers

Question 27

What is a potential derm complication of urinary incontinence?

Answer 27

contact dermatitis (incontinence associated dermatitis)

Question 28

why would we pee our pants if we get scared if sympathetic retains urine and parasympathetic releases urine?

Answer 28

limbic system throws sympathetic function out of whack