Term
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Definition
| involuntary loss of urine which is objectively demonstrable & a social or hygienic problem |
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Term
| Physical Consequences of Urinary Incontinence |
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Definition
skin breakdown;
infections;
falls; |
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Term
| Psychological Consequences of Urinary Incontinence |
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Definition
poor self-esteem;
embarrassment;
depression;
sleep disturbance |
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Term
| Social Consequences of Urinary Incontinence |
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Definition
restricted activities;
reduced interactions;
avoidance of sexual interactivity; |
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Term
| Economic Consequences of UI |
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Definition
primary care evaluation;
medication & supplies;
occupation issues/absence;
nursing home placement |
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Term
| Transient or Reversible Urinary Incontinence |
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Definition
D - delirium & dementia;
I - infections;
A - atrophic vaginits or EtOH ingestion;
P - pharmacologic agents;
P - psychological causes (depression, grief);
E - endocrine disorders (hyperglycemia, hypercalcemia);
R - restricted mobility (physical restraints & environmental barriers);
S - stool impaction |
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Term
| Urge Urinary Incontinence (UUI) |
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Definition
bladder overactivity;
urinary urgency & frequency;
inappropriate detrusor muscle contractions during filling phase;
leakage of urine w/ sudden, strong desire to void;
>8 urinations per day;
>1 urination per night;
Nocturnal incontinence;
Sudden, compelling desire to urinate that is difficult to delay; |
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Term
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Definition
normal aging;
neurologic dx (Stroke, Parkinsons, MS, spinal cord injury) |
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Term
| Stress Urinary Incontinence (SUI) |
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Definition
urethral underactivity;
weakness of pelvic floor musculature & urethral sphincter malfunction;
Leakage of urine occurs w/ increase in abdominal pressure (coughing, sneezing. laughing, straining, lifting, exercise);
Most common in women;
Minimal nocturnal symptoms |
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Term
|
Definition
urethral overactivity +/- bladder underactivity;
uncommon form of dx;
leakage of urine associated w/ overfilled bladder;
Resistance to flow of urine during voiding (BPH, prostate carcinoma, urethral stricture);
Weakened detrusor muscle of bladder (autonomic neuropathy, damage to bladder innervations);
Obstructive Sx: hesitancy, dribbling, poor stream, incomplete emptying;
OR
Irritative Sx: urgency, frequency, nocturia; |
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Term
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Definition
leakage sx are variable & cause is variable;
combination of different types of incontinence;
treat voiding sx which are most bothersome; |
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Term
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Definition
leakage of urine occurs w/ normal bladder & urethral function;
Common in debilitated & institutionalized geriatric pts;
Individuals unwilling or unable to reach toilet to urinate (functional disabilities, environmental factors, psychological unwillingness, cognitive impairment) |
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Term
| anticholinergics, opioid analgesics, calcium channel blocker |
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Definition
| drugs that cause constipation, urinary retention |
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Term
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Definition
| drugs that affect urgency, frequency, and polyuria |
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Term
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Definition
| drug that causes cough --> stress urinary incontinence (SUI) |
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Term
| sedatives, hypnotics, antipsychotics |
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Definition
| drugs that cause confusion, impaired mobility |
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Term
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Definition
Abdominal: masses, bladder distention;
Neurologic: cognitive fcn, mobility, dexterity;
Rectal: prostate size, fecal impaction;
Pelvic: atrophic vaginitis, prolapse;
Skin: rash, infection; |
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Term
| Postvoid Residual Urine Volume (PVR) |
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Definition
amount of urine remaining in bladder after complete voiding;
outlet obstruction or bladder weakness --> high volume of urine;
>100-200 mL left in bladder is SIGNIFICANT |
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Term
|
Definition
Absorbent products;
Lifestyle modifications;
Environmental modifications;
Behavioral Interventions;
Urine Collection Devices |
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Term
| Absorbent Products - pads, shields, guards, undergarments, briefs |
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Definition
management of UI after primary care evaluation;
products absorb various amounts of urine;
counsel about proper skin care |
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Term
| Considerations for Product Selection |
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Definition
funtional disability of pt;
type or severity of incontinence;
time of incontinence;
pt gender;
caregiver availability;
pt preference;
success or failure of previous products;
cost of product; |
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Term
|
Definition
regulate fluid intake;
eliminate bladder irritants;
maintain bowel regularity;
weight management; |
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Term
| Environmental Modification |
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Definition
bathroom aids or bedside commode;
adjust toilet height;
decrease toilet distance;
unrestrictive clothing; |
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Term
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Definition
Pelvic Muscle Exercises (Kegel Exercises);
Timed Voiding;
Prompted Voiding;
Bladder Training; |
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Term
| Pelvic Muscle Exercises (Kegel Exercises) |
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Definition
regimen of exercises designed to strengthen pelvic floor muscles;
locate pelvic floor muscles by "imagining stopping urine flow";
1) empty bladder;
2) tighten pelvic floor muscles & hold for 3 sec;
3) relax muscles for 3 sec or for as long as muscles were tightened;
4) Goal is to increase to 5 then 10 sec as muscles get stronger;
5) increase up to 10 exercises at a time and 3x/day |
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Term
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Definition
| toileting ona fixed schedule, usually every 2 hrs while awake |
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Term
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Definition
| caregiver asks if pt needs to void at appropriate & scheduled times during the day; |
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Term
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Definition
| scheduled toileting w/ progressively increasing voiding intervals using relaxation & reinforcement techniques |
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Term
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Definition
condom attached to tube that drains urine into collection bag;
for men |
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Term
| Intermittent Bladder Catheterization |
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Definition
catheter inserted & removed for each emptying;
used for overflow incontinence due to inability of bladder to contract; |
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Term
| Indwelling Bladder Catheter |
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Definition
use if PVR >300-400 mL;
catheter remains in bladder for long period of time;
used for overflow incontinence due to obstruction;
Avoid due to risk of UTIs |
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Term
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Definition
resolve acute medical illness;
tx chronic medical conditions;
D/C offending medication; |
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Term
| Tx of Urge Urinary Incontinence (UUI) |
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Definition
Identify & manage exacerbating factors --> caffeine, EtOH, etc;
Adjust timing & amount of fluid ingested;
1st line: bladder training regimens;
Augmentation: pharmacotherapy, use anticholinergics - targets uninhibited bladder contractions; |
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Term
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Definition
anticholinergic;
5 mg IR tab, 5 mg/5ml syrup;
PK: extensive 1st pass metabolism by CYP 3A4, active metabolite, fluctuation in plasma conc;
Dosing:
Initial - 2.5 mg BID;
Max - 5 mg TID;
Take on empty stomach |
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Term
| oxybutinin ER (Ditropan XL) |
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Definition
antimuscarinic;
5 mg, 10 mg 15 mg ER tabs;
PKs: reduced 1st pass metabolism, lower metabolite formation, fairly constant plasma conc.;
Dosing:
Initial - 5 mg qd;
Max - 30 mg qd;
Take w/ or w/o food;
Do not crush, chew, or divide; |
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Term
| oxybutinin patch (Oxytrol) |
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Definition
antimuscarinic;
3.9 mg/day transdermal system;
PKs: thin flexible clear patch, absorbed by passive diffusion, bypasses 1st pass metabolism;
Dosage:
Apply 1 patch twice weekly (every 3-4 days);
Apply to clean, dry skin on abdomen, hip, or buttocks;
Avoid re-application to same site in 7 days;
Do not cut or trim patch;
Keep patch away from direct sunlight;
Do not use EtOH --> increased dizziness, drowsiness; |
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Term
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Definition
Antimuscarinic
20 mg IR tab;
Recommended: 20 mg BID in AM & HS;
Take 1 hr before meals or on empty stomach;
Food reduces bioavailability;
Decrease to 20 mg once daily in renal impairment; |
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Term
| trospium ER (Sanctura XR) |
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Definition
antimuscarinic;
60 mg ER capsule;
Dosing:
Take 60 mg qAM;
Take on empty stomach; |
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Term
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Definition
antimuscarinic;
4 mg, 8 mg ER tabs
Dosing:
Initial - 4 mg once daily;
Range - 4-8 mg once daily;
Do not crush, chew, or divide;
Do not exceed 4 mg daily for pts w/ severe renal impairment or current use of potent CYP 3A4 inhibitors;
Avoid in hepatic impairment |
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Term
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Definition
antimuscarinic;
1 mg, 2 mg tabs
Dosing:
Initial - 2 mg BID;
Range - 1-2 mg BID;
Do not exceed 2 mg daily for pts w/ significat renal & hepatic dysfunction;
TOTALLY AVOID if severe hepatic impairment;
Metabolized by CYP 2D6, forms active metabolite; |
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Term
| tolterodine ER (Detrol LA) |
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Definition
antimuscarinic;
2 mg, 4 mg ER tabs
Dosing
Initial - 4 mg once daily;
Range - 2-4 mg once daily;
Do not crush, chew, divide;
Use 2 mg dose for pts w/ reduced renal & hepatic fcn;
Avoid in severe hepatic impairment;
Metablized by CYP 2D6, active metabolite; |
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Term
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Definition
antimuscarinic;
5 mg, 10 mg tab
Dosing:
Initial - 5 mg once daily;
Max - 10 mg once daily;
Take w/ liquids & swallow whole;
AVOID w/ severe hepatic impairment;
Do not exceed 5 mg daily dose w/ moderate hepatic impairment, severe renal impairment, and current use of CYP 3A4 inhbiitors; |
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Term
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Definition
antimuscarinic;
7.5 mg, 15 mg ER tabs;
Metabolized by CYP 2D6, CYP 3A4;
Dosing:
Initial - 7.5 mg once daily;
Max - 15 mg once daily;
AVOID w/ severe hepatic impairment;
Do not exceed 7.5 mg dose w/ moderate hepatic impairment, current use of CYP 3A4 inhibitors |
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Term
| Contraindications w/ Antimuscarinics |
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Definition
| urinary retention, gastric retention, narrow-angle glaucoma, hypersensitivity, bladder outflow obstruction, reduced GI motility, reduced hepatic fcn, reduced renal fcn |
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Term
| Adverse Effects of Antimuscarinics |
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Definition
| dry mouth, blurry vision, constipation, dyspepsia, drowsiness, dizziness, tachycardia, HA |
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Term
| Drug Interactions w/ Antimuscarinics |
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Definition
| macrolides (clarithromycin), azole antifungals (itraconazole), protease inhibitors (ritonavir), antihistamines, skeletal muscle relaxants, TCAs, antipsychotics |
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Term
| Monitoring Parameters for Urinary Incontinence |
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Definition
Urinary symptoms (urgency, frequency, nocturia) --> use bladder diary;
Incontinence episodes;
adverse effects;
quality of life |
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Term
| Tx of Overflow Urinary Incontinence |
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Definition
Remove offending drug or tx chronic dx process;
catheterization indicated for acutely obstructed pt;
Pharmacotherapy aimed at decreasing urethral pressure --> alpha-adrenergic antagonists or 5-alpha reductase inhibitors;
Anticholinergics useful if irritative symptoms persist; |
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Term
| alpha-adrenergic antagonist |
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Definition
1st line tx of overflow urinary incontinence (mainly due to BPH);
relaxes smooth muscle in prostate & bladder neck; |
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Term
| Tx of Stress Urinary Incontinence (SUI) |
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Definition
Identify & manage individual exacerbating factors;
1st line: pelvic floor exercises;
2nd line: pharmacotherapy, no FDA approved meds just off-label use (alpha adrenergic agonists (PSE, PE, ephedrine), HRT, duloxetine (Cymbalta), Surgical Options:
females - reposition urethra or create support w/ sling;
males - artificial urinary sphincter |
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Term
| alpha adrenergic agonists (pseudoephedrine, ephedrine, phenylephrine) |
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Definition
stimulates alpha adrenergic receptors in bladder neck & proximal urethra;
Off-label use to treat Stress Urinary Incontinence;
ADRs: HTN, HA, insomnia, restlessness, N;
C/Is: HTN, CAD, renal failure, tachyarrhythmias, hyperthyroidism, narrow-angle glaucoma |
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Term
| Hormone Replacement Therapy (HRT) |
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Definition
thought to enhance proliferation of urethral epithelium;
Conflicting results;
Oral agents NOT RECOMMENDED due to long-term risks;
Only topical agents for tx of urethritis or vaginitis coexist; |
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Term
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Definition
off-label use to tx Stress Urinary Incontinence;
increases urethral resistance to leakage during periods of urine storage;
ADRs: N, HA, constipation |
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