Urinary Incontinence

  1. Define urinary incontinence
    • involuntary leakage of urine
    • can interfere with QOL and lead to depression and perceived loss of independence
    • UI is half as common in men then in women
  2. what receptors in the base and neck of the bladder keep the internal sphincter contracted?
  3. what receptors in the bladder body keep the detrusor muscles relaxed
  4. types of UI are due to problems with:
    bladder, urethra, or both
  5. Urethral Underactivity (Stress Urinary Incontinence)
    • occurs during exercetional activities (exercise, running, lifting, coughing, sneezing)
    • urethral sphincter can not resist flow of urine from the bladder due to increasaed abdominal pressure that occurs during the activity
  6. risk factors of urethral underactivity (stress urinary incontinence)
    • pregnancy
    • child birth
    • menopause
    • cognitive impairment
    • obesity
    • age
    • surgery (prostate surgery)
    • injury
  7. bladder overactivity (urge urinary incontinence)
    • detrusor muscle is overactive and inappropriately contracts during filling
    • 2types: overactive bladder and detrusor overactivity
  8. overactive bladder
    urinary urgency with frequency and nocturia that may occur with our without urinary incontinence
  9. detrusor overactivity
    requires urodynamic diagnosis showing involuntary detrusor contraction during the filling stage
  10. risk factors for urge urinary incontinence
    • age
    • neurologic disease
    • BPH or prostate cancer
  11. over-flow incontinence
    • uncommon
    • bladder is filled to capacity but is unable to empty which allows urine to leak
    • urethral overactivity- resistance to flow of urine is increased which leads to obstruction and incomplete bladder emptying
    • detrusor muscle becomes weakened and loses its ability to voluntarily contract
  12. diuretics
    polyuria, frequency
  13. alpha-receptor antagonists
    urethral relaxation
  14. CCB
    urinary retention
  15. narcotics
    urinary retention
  16. antipsycotics
    urinary retention
  17. anticholinergics
    urinary retention
  18. ACE inhibitors
    cough-stress incontinence
  19. immediate-release oxybutynin
    • ditropan-anti-muscarinic agent
    • gold standard, titrate slowly to prevent side effects of dry mouth, constipation, vision impairment, confusion, cognitive impairment, orthostatic hypotension, sedation, weight gain
    • no hepatic or renal adjusments
  20. extended-release oxybutynin
    • ditropan xl
    • max effect may take 4 weeks
    • no hepatic or renal adjustments
  21. extended-release transdermal oxybutynin
    • ditropan
    • apply patch twice weekly every 3 to 4 days, lower concentrations of active metabolites because avoids first pass
  22. immediate release tolterodine
    • detrol
    • may take up to 8 weeks to see max benefit
    • hepatic and renal adjustments
    • interactions with antacids and PPIs lead to rapid release of the drug
    • dizziness, dyspepsia, HA, vision disturbances, constipation
  23. Tospium chloride
    • Sanctura
    • take on an empty stomach
    • Non CYP
    • no hepatic adjustments BUT need renal adjustments
  24. solifenacin succinate
    • Vesicare
    • no advantage over other agents
    • hepatic and renal adjustments
    • dry mouth, constipation, blurred vision
  25. darifenacin
    • Enablex
    • no advantage over the other agents
    • hepatic adjustments and no renal
    • dry mouth, constipation
  26. fesoteridine
    • Toviaz
    • no advantage over other agents
    • hepatic and renal adjustments
    • dry mouth, constipation, HA, dry eye
  27. Botulinum Toxin A
    • direct injection into the muscle leads to paralysis
    • still being studied but appears can receive injections every 3 to 9 months
    • side effects are dose related- detrusor underactivity and urinary retention
  28. Cartheterization combined with medications
    • usually in patients with urge incontinence that also have elevated post void residuals
    • patients would intermittenly self carherize to prevent surgical placement of a catheter
    • to help increase bladder storage any of the above medications can be used along the with catherization
  29. stress incontinence tx
    • alph-adrenergic receptor blockers: prazosin, terasozin, doxazosin, tamulosizin, alfuzosin, methyldopa, chlonidine, guanfacine, labetolol
    • improves urethral closure by stimulating the receptors in the bladder neck
Card Set
Urinary Incontinence
Therapeutics 4