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Incontinence :face_with_cowboy_hat: (Hypertonic, Motor Urge (Overactive…
Incontinence :face_with_cowboy_hat:
recognize, only
stress incontinence
is unique to :female_sign:: cardinal ligament & previous birth req.
pay attention to s/s (urge to void) & nocturnal sx
pay attention to Dx testing: PEx, UA, cystometry : know when to use which test
should be straightforward to not confuse
Stress Incontinence ( :female_sign:only)
Path: Big or Multiple births :pregnant_woman::skin-tone-4: (older :female_sign:)
stretches cardinal ligament = floppiness
Cystocele forms; when theres abn pressure, urine is pushed out stretching bladder
Pt: Sneeze :sneezing_face: & pee
any increase in abn pressure!
:forbidden:Urge
:forbidden:nocturnal s/s :waxing_crescent_moon:
Dx: Clinical
PEx: Cystocele
:check:
positive Q tip test
( applying Q tip to urethra, apply pressure: if rotation is > 30º = urethral mobility =
stress incontinence
:pencil2:
UA
=normal
cystometry
= normal
don't get, don't need
Tx:
Kegel exercises
:weight_lifter::skin-tone-4: (prob won't work)
Pessaries
Sx if bad enough (MMK, Birch procedures: tack bladder in correct position)
(
top
: normal, pressure evenly applied to urethra & bladder;
bottom
: urethra prolapses into vagina, Pressure only applied to bladder= urine leak)
Hypertonic, Motor Urge (Overactive bladder OAB)
Path: random spasms :zap: of detrusor muscle.
nothing sets it off.
Pt: always looking for a bathroom :open_mouth:(
Urge to pee
) but only can pee a little
Nocturnal
also :waxing_crescent_moon:
Leaks w/ every contraction
Dx: motor problem =
cystometry
PEx : normal
UA : normal (r/o infx)
Cystometry = shows spasms
Tx:
Antispasmotics: Oxybutynin
(right answer)
newer meds available.
:warning:Overtreating w/ antispasmodics removes all detrusor fn. Leads to hypotonic (overflow)
Mnemonic:
"
O
veractive
B
ladder =
O
xy
B
utynin"
Cystometry Procedure
Pt voids to nothing
accumulate urine to max
Measure detrusor contractions
Random spikes of activity regardless of volume
Hypotonic, Overflow (Neurogenic bladder) :face_with_cowboy_hat:
Path: Absent detrusor contractions
severed neural system: can't feel fullness or can't push out pee (contracting)
peeing normally involves sphincter relaxation/ bladder contraction
done when feeling the urge to void
Classically seen in:
MS
Trauma :explode:
Antispasmodic Rx
Pt: Leaks before bladder explodes. :balloon: Wall tension expels some urine, below that threshold there is no leak.
:forbidden:Urge
Nocturnal symptoms :waxing_crescent_moon:
regular leaks thorughout day :sunny: (not continuous)
:pencil2:Not hard to Dx chronically (MS pt who caths)
initial Dx will be tougher
Dx:
PEx : distended bladder
Focal neuro deficit explains cause (paraplegic :wheelchair:, etc)
UA : normal
Cystometry
Tx:
Induce spasm = Bethanachol
however pts w/ chronic irreversible, need aggressive therapy:
Intermittent vs. Chronic indwelling Cath.
3 more items...
Irritative Bladder
Path: Inflammation - stones, Ca :crab:, UTI
not necessarily incontinence. Person needs to void and may not make it to :toilet:
Pt: Frequency, urgency, Dysuria
± urgency @ night :waxing_crescent_moon:, but :forbidden:incontinence, just feels need to go
Dx: PEx : normal
UA : WBC (infx), ( :crab:, stones)
(UA only catches these for incontinence)
cystometry
: would be normal
Tx: based on condition
UTI : ABX (amoxicillin , TMP-SMX, nitrofurantoin)
Stones : first image, then capture :goal_net: w/ filtration
Ca :crab: : imaging, then sx
Fistulas
Pt: Continuous Leak : epithelialized communication
bladder to somewhere else (anywhere)
look for reason why they might have fistula:
Inflammation :fire:
& Radiation :radioactive_sign:
sx :hocho:, ca :crab:, IBD :poop: (Crohn's)
Pt:
Continuous leak
also has Normal function (can expel urine through urethra normally)
will also have urinary leakage from vagina, skin, rectum (air/stool in urine)
Dx: PEx (hopefully see fistula)
UA
: more like U-seless
cystometry
: no need
Tampon test
place tampon where you think the exit of fistula is. (vag/rectum/skin)
Inject blue dye in to bladder
:check: if tampon turns blue
Tx: Sx resection (
Fistulotomy
)
