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Urinary Incontinence PowerPoint Presentation

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Description : This medical presentation titled "Urinary Incontinence" by Kathleen Pace Murphy, PhD, MS, APRN, Assistant Professor, UT Medical School, Geriatric and Palliative Medicine, prevalence, risk factors, physical examination, diagnostic testing, and treatment of Urinary Incontinence

Tags : urinary Incontinence, genecology, women, prevalence, risk factors, physical examination, diagnostic testing, treatment

Published on : Apr 18, 2021 | Views : 4219 | Downloads : 6

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Slide 1-

Urinary Incontinence Kathleen Pace Murphy, PhD, MS, APRN Assistant Professor, UT Medical School Geriatric and Palliative Medicine
Slide 2-

Prevalence Increases with age and affects women more than men (2:1) until age 80 15-30% in community dwellers age 65 and older 60-70% in older adults age 65 and older in long term care Significantly impairs quality of life
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Risk Factors Obesity Functional impairment Dementia Medications Environmental barriers to toilet access
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Age related LUT changes Bladder contractility decreases Uninhibited bladder contractions increase Diurnal urine output occurse later in day Bladder capacity decreases Sphincteric striated muscle attenuates PVR increases
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Age related LUT changes- Women In addition to the physiologic changes already discussed: Urethral closure pressure decreases Vaginal mucosal atrophy
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Age related LUT changes- Men In addition to the physiologic changes already discussed: Benign prostatic hyperplasia Prostate hypertrophy
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LUT Pathophysiology in UI Urge UI Urge UI with detrusor overactivity (uninhibited bladder contractions) 40% on urodynamic testing Suggest detrusor overactivity PLUS impaired compensatory mechanisms. Idiopathic, age-related, secondary to lesions in cerebral and spinal pathways. Due to bladder outlet obstruction or bladder irritation (infection, stones, tumor)
Slide 8-

LUT Pathophysiology in UI Stress UI Etiology Damage to the pelvic floor supports Sphincter failure Leakage associated with coughing, sneezing, laughing, physical activity Second most common form in women Seen in men after prostectomy
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LUT Pathophysiology in UI Mixed UI with both detrusor overactivity and impaired sphincter support Leakage occurs with both urgency and activity Seen in women
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LUT Pathophysiology in UI UI with impaired bladder emptying Increase PVR (200mL) Intermittent small dribbling Frail elderly: coexistence of urge UI and PVR (in the absence of bladder outlet obstruction)= detrusor hyperactivity with impaired contractility (DHIC) Men prostate hypertrophy Women urethral surgical scarring Large cytocele/prolapse
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UI Screening and Evaluation Multifactorial evaluation Comorbidity Funciton Medication Questions to ask Do you have any problems with bladder control? Do you have any problems making it to the bathroom on time? Do you ever leak urine?
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Medications Associated with UI Alcohol Alpha-adrenergic agonists Alpha-adrenergic blockers ACE Inhibitors Anticholinergic Antipsychotics CCB Cholinesterase inhibitors Estrogen Gabapentin Loop diuretics Narcotics NSAIDs Sedative hypnotics Thiazolidinediones TCA
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UI Red Flags Abrupt onset Pelvic pain (constant, worsened, or improve with voiding) Hematuria
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Physical Examination Rectal Exam Masses, fecal loading, prostate nodules or firmness Neuro Exam Sacral cord integrity (sensory) Perianal wink (motor) Pelvic Exam Labial and vaginal lesions Pelvic organ prolapse Psychological Exam Association between depression and UI Sleep apnea- nocturia association
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Diagnostic Testing Urinalysis Hematuria, glycosuria Bladder diaries (time, volume & UI episode x 48 hr) Urodynamics Only in uncertain diagnosis
Slide 16-

UI Treatment and Management Lifestyle Management Weight loss (SOE=A) Extreme fluid intake Limit caffinated beverages Limit ETOH Limit evening fluid intake Quit smoking (stress UI)
Slide 17-

UI Treatment and Management Behavioral Therapies A. Bladder training and pelvic muscle exercises 1. Effective urge, mixed, and stress UI (SOE=A) B. Prompt timed voiding in cognitively impaired C. Biofeedback for PME 1. Medicare covers (SOE=Unkown)
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Medications Anti Muscarinics MOA Increase bladder capacity by decreasing basal excretion of Ach from urothelium Contraindicated Narrow angle glaucoma Impaired gastric emptying Known urinary retention Patient taking cholinesterase inhibitor Drugs Oxybutynin Tolterodine Fesoterodine Trospium Darifenacin Solifenacin
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Medications Rx UI and OAB MOA Stimulation of beta 3 receptors in the detruor mediates bladder relaxation: Myrbetriq 25-50mg QD ADE Increase blood pressure Prescribe carefully in patient with renal and hepatic impairment Many drug-drug AE like muscarins
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Other Treatments Intravesical injection of botulinum toxin Sacral nerve neuromodulation Surgery (stress UI) Colpsuspension (Burch Operation) Slings (synthetic mesh, or autologus or cadaveric fascia)
Slide 21-

References Flaherty E & Resnick B Geriatric Nursing Review Syllabus (4th Ed). New York: American Geriatric Society; 2014. Gulur DM, Mevcha AM, Drake MJ. Nocturia as a manifestation of systemic disease. BJU Int. 2011; 107 (50): 702-13. Ham, RJ, Sloan, PD, Warshaw, GA, Potter, JE & Flaherty E. Primary Care Geriatrics: A case-based approach (6th Ed.). 2014. Philadelphia: Elsevier Saunders. Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Strauss SE. What type of urinariy incontinence does this woman have? JAMA, 2008 : 299: 1446-56. Landefeld CS, Bowers BJ, Feld AD et al. NIH state-of-the-science-conference statement: Prevention of fecal and urinary incontinence in adults. Ann Intern Med 2008:148: 449-58. Shamliyan T, Wyman J, Kane RL. Benefits and harms of pharmacologic treatment for UI in women: A systematic review. Ann Intern Med 2012: 156(12): 861-74.