Urinary Incontinence

Question 1

What are some of the bothersome urinary symptoms for overactive bladder?

Answer 1

• Urinary Urgency - sudden feeling to pee (normally with or without incontinence and accompanied by frquency & nocturia
• Urinary Frequency - > 8 times during the day
• Nocturia
• Urinary Incontience - leakage

Question 2

What are the forms of urinary incontinence?

Answer 2

• Urge
• Stress
• Mixed
• Functinal
• Overflow

Question 3

What is urge as it relates to urinary incontinence?

Answer 3

• A Sudden and unstopable urge to pee
• Associated with Neuropathy and is present in those with diabetes, strokes, dementia, parkinsons, or MS

Question 4

What is stress as it relates to urinary incontinence?

Answer 4

• Urine leaks out during any form of exertion (cough, exercise, sneeze, laugh)

Question 5

What is Mixed as it relates to urinary incontinence?

Answer 5

• Combo of urge and stress

Question 6

What is funcitonal as it relates to urinary incontinence?

Answer 6

• no issues with Bladder but the patient may be hindered in some way where they cant access the bathroom

Question 7

What is overflow as it relates to urinary incontinence?

Answer 7

• Leakage that happens because the bladder is too full (BPH is the most common cause)

Question 8

What is the way that the bladder works in our body?

Answer 8

• Has detrusor muscle which helps coordinated to store and expel urine (gets innervated by the parasympathetic NS via acetylcholine on muscarnic receptors)

Question 9

How does overactive bladder occur in the body?

Answer 9

• inappropriate stimulation of the muscarinic receptors on the detrusor muscle causing the involuntary contractions = URGENCY
• M3 receptor is responsible for both emptying contractions and involuntary contractions

Question 10

What are some risk factors for overactive bladders?

Answer 10

• Age > 40
• Diabetes
• Prior Vaginal Delivery
• Obesity
• Neurologic Conditions (Parkinsons, Stroke, Dementia)
• Drugs that Increase incontinence

Question 11

What are some non drug treatment options for overactive bladders?

Answer 11

• Behaviroal Therapies (bladder training, delayed or scheduled peeing, Pelvic floor muscle exercises [Kegel], urge control, fluid management,…) are 1st line

Question 12

What are some of the drug treatments for someone with overactive bladder?

Answer 12

• Anticholinergic Medications
• Beta-3 Agonist
• Onabotulinumtoxin A (Botox A)
• Nerve Stimulation or Surgical Treatments

Question 13

What is the MOA for the anticholinergic drugs?

Answer 13

• Also called antimuscarinic drugs; they bind to muscarinic receptors and block acetylcholine from binding = limits the detrusor muscle actions

Question 14

What are some of the anticholinergic agents used for overactive bladder?

Answer 14

• Oxybutynin IR, ER (Ditropan XL), Patch (4 days on)
• Tolterodine (Detrol) & ER (Detrol LA)
• Trospium IR, XR (take on empty stomach)
• Solifenacin (Vesicare) [M3 Selective]
• Darifenacin [M3 Selective] (NOT injection)
• Fesoterodine (toviaz) [M3 selective]

M3 Selectives have fewer CNS side effects

Question 15

What are some warnings for the anticholinergic agents used for overactive bladder?

Answer 15

• Agitation, Confusion, drowsiness, dizziness, blurred vision (caution in those that are doing task that required mental alertness)

Question 16

What are some contraindications for the anticholinergic agents used for overactive bladder?

Answer 16

• Narrow angle glaucoma

Question 17

What are some additional notes for the anticholinergic agents used for overactive bladder?

Answer 17

• Decreased dose with renal impairments
• Ditropan XL is an OROS form = Ghost Shells
• Oxy Patch (4 days on) & Gel cause less dry mouth

Question 18

What are some anticholinergic effects?

Answer 18

• Dry eye/blurred Vision
• Urinary Retention
• Dry Mouth
• Constipation
• Tachycardia
• Sedation
• Dizziness
• Cognitive Impairment

Cant See, Cant Pee
Cant Spit, Cant Shit

Question 19

What are some treatment options that could minimize the dry mouth side effects from the anticholinergic agents

The main reason why people stop using these medications

Answer 19

• Try the ER verisons
• Try Oxybutynin gel or patch (4 days on)
• Beta-3 Agonists have lower dry mouth risks
• NON-drug options

Question 20

What is the MOA for the Beta-3 agonists used for overactive bladder?

Answer 20

• Relaxes the detrusor muscle and increases the bladder capacity by activating Beta-3 receptors

Question 21

What are the beta-3 agonist that are used for overactive bladders?

Answer 21

• Mirabegron (Mybetriq)
• Vibegron (Gemtesa)

Question 22

What are some warnings for the beta-3 agonists used for overactive bladder?

Answer 22

• Urinary Retention in those with BPH and when used with anticholinergic drugs
• Mirabegron: increase BP & less dry mouth

Question 23

What is the MOA for OnabotulinumtoxinA (Botox)?

Answer 23

• For those that are refractory to the 1st and 2nd line treatments; affects the detrusor activity by inhibiting the release of acetylcholine

Question 24

What drug is used for noctuira and what is the MOA

Answer 24

• Desmopression
• MOA: antidiuretic hormone analog that temporarily decreases urine production

Question 25

What are some **boxed warnings** for the **desmopressin** used for **nocturia**?

Answer 25

- Severe, life threating **hyponatremia** can happen

Question 26

What are some **contraindications** for the **desmopressin** used for **nocturia**?

Answer 26

- Fluid retention