Term
| what is one of the biggest reasons women are admitted to nursing homes? |
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Definition
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Term
| what is "stress incontinence"? (*probable exam question*) |
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Definition
| the loss of urine during increase abdominal pressure (cough, sneeze, laugh) - either due to 1) urethral hypermobility or 2) intrinsic (internal) sphincter deficiency (IFD - lack of normal intrinsic pressure in the urethra from age/lack of estrogen/sx/neurologic lesions) |
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Term
| what changes in fascia can lead to stress incontinence? |
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Definition
| tearing of the pubocervical fascial sling which usually holds the urethra in position - often occurs in birth. |
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Term
| how can birth lead to a cystocele? what are the consequences of this? |
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Definition
| if the anterior fascia is disrupted - the bladder can hang down in the vagina. a cystocele can lead to urinary retention, which then causes frequency etc. |
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Term
| what is overactive bladder (urge incontinence)? |
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Definition
| the involuntary loss of urine preceded by a strong urge to void whether or not the bladder is full. urgency, frequency, dysuria, nocturia may result. this may also be referred to as detrusor instability/hyperreflexia. |
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Term
| what leads to overactive bladder (urge incontinence)? |
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Definition
| UTI, CA, stones, interstitial cystitis - most *mostly idiopathic*. |
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Term
| what is functional incontinence? |
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Definition
| untimely urinary b/c of physical disability, external obstacles, or problems in thinking/communicating that prevents a person from reaching the toilet. |
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Term
| what is mixed incontinence? |
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Definition
| when genuine stress incontinence is combined w/overactive bladder. |
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Term
| what is overflow incontinence? how does it present? what is usually the cause? how is this diagnosed? |
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Definition
| unexpected leakage of small amounts of urine from a full bladder - can present as dribbling, OAB, or stress incontinence. usually due to *underactive bladder muscle or *outlet obstruction as a result of: drugs/DM neuropathy/spinal cord injury/radical pelvic sx (main cause of outlet obstruction in women: overtightened urethra)/MS. dx: cystometric studies. |
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Term
| what kinds of fistulas can lead to incontinence? what are possible causes of this? |
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Definition
| vesicovaginal, which currently most are due to iatrogenic causes - but in the past, prolonged labor caused fistulas. |
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Term
| what are some of the causes of incontinence? |
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Definition
| atrophic vagina (change in pH, loss of lactobacilli), diverticula, fistula, poor vaginal muscle tone (childbirth), obesity/ascites/masses (pressure), bladder stones, UTI, constipation, interstitial cysts, and smoking (irritates bladder) |
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Term
| might urinary incontinence be due to a rx? |
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Definition
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Term
| what are causes of temporary incontinence? |
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Definition
| etoh, caffeine, overhydration, dehydration, carbonated drink, *artificial sweeteners*, spice, high acid foods, and sugar |
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Term
| what is the number one thing for any work up? what else needs to be done for incontinence pts? |
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Definition
| H+P, followed by check for post-void residual (US/catheter), urinalysis (cytology, glucose, blood)/cx, voiding diary (figure out behavioral fix), check drugs, consider cystometry (time urination time, if prolonged - consider MS/sx repair etc), cystoscopy, Q-tip test (q-tip into urethra, have pt cough - if it moves = lack of anterior wall support = urethral hypermobility), and consider US (pregnancy/tumor). |
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Term
| if a pt leaks urine unaware, what might be the cause? |
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Definition
| dysfunctional internal sphincter |
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Term
| what should the physical exam for a incontinence pt consist of? |
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Definition
| void before exam (then get a post void residual), send urine for cx/cytology, r/o diastasis recti, masses, ascites, and organomegaly, check pulmonary/cardiac status for cough/meds that may aggravate, assess lumbosacral roots w/DTR as well as the bulbocavernosus/clitoral reflex, and check for inflammation/atrophy/infection |
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Term
| how is stress incontinence treated? |
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Definition
| kegel's, cones, pelvic floor electrical stimulation (cures 38% in 3 mos), pessary, sx (retropubic sling), bulking agents (collagen, coaptite, and durasphere), a sacral nerve stimulator (interstim), botox, and radio-frequency tx to change collagen |
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Term
| what is the problem w/tolterodine (detrol) as an anticholinergic to help w/incontinence? |
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Definition
| it can cause memory problems (exacerbates already present issues in the elderly), as well as dry mouth, blurred vision, confusion, etc. |
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