Info
🌱 來自: Huppert’s Notes
Urinary Incontinence🚧 施工中
Urinary Incontinence
•Physical exam: Abdominal exam, rectal exam, pelvic exam in females, consider post-void residual
•Differential diagnosis:
- Urge incontinence
• Symptoms: Sudden urge to urinate such that the patient may not make it to the bathroom, nocturnal bed-wetting. More common in elderly patients.
• Diagnosis: Urodynamics (incontinence is due to an overactive detrusor muscle)
• Treatment: Bladder training, anticholinergic (oxybutynin), TCA (imipramine)
- Stress incontinence
• Symptoms: Spurts of urine loss during activities that increase intra-abdominal pressure (coughing, laughing, sneezing, exercising). More common in multiparous women.
• Diagnosis: Positive cough test, weakness of pelvic floor/sphincter leads to loss of bladder support
• Treatment: Pelvic muscle (Kegel) exercises, pessary placement, surgery (urethropexy)
- Overflow incontinence
• Symptoms: Bladder does not empty completely, overdistension may lead to dribbling of urine. The patient may have a history of spinal cord injury or bladder outlet obstruction
• Diagnosis: Elevated post void residual (PVR) due to obstruction
• Treatment: Bethanechol, alpha-blockers (tamsulosin), surgical intervention to relieve obstruction
• Diagnosis: In addition to the tests above, exclude causes of secondary urinary incontinence:
- Infection: UA to assess for urinary tract infection
- Constipation: Rectal exam to assess for stool impaction
- Functional status: Low mobility may be contributing to physical ability to reach the toilet
- Mental status: Delirium or dementia may be contributing to cognitive ability to reach the toilet
- Lifestyle: Assess for alcohol use, uncontrolled diabetes
- Medications: Diuretics, sedating medications, opioids