Urology Book

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Urinary Incontinence

Aka: Urinary Incontinence, Incontinence
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  1. Epidemiology
    1. Increased prevelance with age
      1. Age 44 year women: 17%
      2. Age 75 year women: 27%
    2. High Incidence in female athletes
      1. Female Varsity Athletes: 32%
      2. Female Basketball players: 68%
  2. Physiology
    1. Physiology of urination and Bladder control
      1. Detrussor muscle (Bladder) control
        1. Parasympathetic innervation
        2. Beta adrenergic control
      2. Internal Urethral sphincter
        1. Alpha adrenergic control
      3. External Urethral sphincter
        1. Somatic or voluntary control
    2. Incontinence is not a normal part of aging
      1. Age predisposes to Incontinence
      2. Age does not cause Incontinence
  3. Pathophysiology
    1. Disorders of Urinary Storage
      1. Detrussor Hyperactivity
        1. Urge Incontinence
      2. Sphincter incompetence
        1. Urge Incontinence
        2. Stress Incontinence
    2. Disorders of Urine Emptying
      1. Detrussor hypoactivity
        1. Overflow Incontinence
      2. Urethral Sphincter obstruction
        1. Overflow Incontinence
  4. Types of Urinary Incontinence
    1. Low Pressure Urethra (Type 3)
      1. Urethral tone loss (<60 cm H20)
      2. Causes: trauma, surgery
    2. Overflow Incontinence (Urinary Retention)
      1. Bladder overdistention with Urinary Retention
      2. Post-void residual >200 cc of urine
      3. Less common in women
      4. Causes: Neuropathy, BPH, or pelvic mass
      5. Requires evaluation for tumor mass
    3. Urge Incontinence (Overly sensitive Bladder)
      1. Loss of large Bladder volumes (contrast with stress)
      2. Associated with urinary urgency, frequency, nocturia
      3. Causes: CNS, Cystitis, Bladder Cancer, stones
    4. Stress Incontinence (Loss of pelvic support at Urethra)
      1. Loss of small Bladder volumes (contrast with urge)
      2. Occurs with coughing, sneezing, lifting
      3. Causes: Urethral hypermobility, Sphincter damage
    5. Functional Incontinence
      1. Normal Bladder with decreased access to toilet
  5. Differential Diagnosis: (Mneumonic: "DIAPPERS") - Causes transient acute Incontinence
    1. Delirium
    2. Infection or Inflammation
      1. Recurrent Urinary Tract Infection
      2. Infectious Vaginitis
      3. Interstitial Cystitis
      4. Carcinoma-in-situ of the Bladder
    3. Atrophic Urethritis or Atrophic Vaginitis
    4. Pharmaceuticals
      1. Diuretics
      2. Sedative-Hypnotic Medications
      3. Antipsychotic medications
      4. Antidepressants
      5. Analgesics including Narcotics
      6. Muscle relaxants
      7. Sympathetic blockers
    5. Psychological causes
    6. Excessive urine output (e.g. Diabetes Mellitus)
    7. Restricted Mobility (i.e. difficult ambulation)
    8. Stool Impaction
  6. Exam
    1. Spontaneous loss of urine
      1. Detrussor Instability
      2. Urge Incontinence
    2. Provocation with cough, valsalva, or bearing down
      1. Suggests Stress Incontinence
      2. Perform Pelvic exam, lifting anterior vaginal wall
        1. Changes Bladder neck position
        2. Retest with cough or valsalva
    3. Spontaneous uncontrolled large volume Bladder emptying
      1. Suggests Urge Incontinence
  7. Diagnosis
    1. See Provoked Full Bladder Stress Test
    2. Urodynamic Testing (Cystometrography)
      1. Indicated for Incontinence not due to stress or urge
  8. Evaluation
    1. Rule-out reversible cause
      1. Medication adverse effects
      2. Atrophic Vaginitis
      3. Benign Prostatic Hyperplasia (BPH)
      4. Polyuria
        1. Medication
        2. Diabetes Mellitus
      5. Fecal Impaction
      6. Urinary Tract Infection
      7. Functional Incontinence
        1. Limited mobility
        2. Altered Level of Consciousness
    2. Rule-out Overflow Incontinence
      1. Check post-void residual if indicated by history
    3. Consider neurologic or post-surgical cause
      1. See Low Pressure Urethra
    4. Distinguish Urge Incontinence from Stress Incontinence
      1. If secondary cause is unlikely
  9. Management: General
    1. Management is per specific Incontinence cause
    2. Make toilets more accessible
      1. Higher toilets
      2. Well lit floors
      3. Change bedroom to be close to bathroom
      4. Consider bedside commode
    3. Wear clothes that are removed easily
    4. Use moderation in fluid intake
    5. Lose weight (if obese)
    6. Smoking Cessation
    7. Avoid Diuretics
      1. Avoid Alcohol
      2. Avoid caffeine
  10. Resources
    1. Help for Incontinent People
      1. Phone: (864) 579-7900
    2. AUA Step By Step Incontinence Treatment
      1. http://www.drylife.org/drylife.html
    3. Bladder Control in Women
      1. http://www.niddk.nih.gov/health/urolog/uibcw/

Urinary Incontinence (C0042024)

Definition (NCI) Inability to control the flow of urine from the bladder.
Definition (NCI) A disorder characterized by inability to control the flow of urine from the bladder.
Definition (MEDLINEPLUS)

Urinary incontinence is loss of bladder control. Symptoms can range from mild leaking to uncontrollable wetting. It can happen to anyone, but it becomes more common with age.

Most bladder control problems happen when muscles are too weak or too active. If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh or lift a heavy object. This is stress incontinence. If bladder muscles become too active, you may feel a strong urge to go to the bathroom when you have little urine in your bladder. This is urge incontinence or overactive bladder. There are other causes of incontinence, such as prostate problems and nerve damage.

Treatment depends on the type of problem you have and what best fits your lifestyle. It may include simple exercises, medicines, special devices or procedures prescribed by your doctor, or surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Definition (NCI) Inability to hold urine in the bladder.
Definition (CSP) failure of voluntary control of the vesical and urethral sphincters, with constant or frequent involuntary passage of urine.
Definition (MSH) Involuntary loss of URINE, such as leaking of urine. It is a symptom of various underlying pathological processes. Major types of incontinence include URINARY URGE INCONTINENCE and URINARY STRESS INCONTINENCE.
Concepts Disease or Syndrome (T047)
MSH D014549
ICD9 788.30, 788.3
ICD10 R32
SnomedCT 207170000, 207174009, 158472009, 158469002, 142633003, 139399005, 165232002, 41840003, 236661008
English Bladder continence, absence, Incontinence, Urinary, BLADDER INCONTINENCE, INCONTINENCE URINARY, MICTURITION INVOLUNTARY, URINARY BLADDER INCONTINENCE, URINARY INCONTINENCE, URINATION INVOLUNTARY, URINE INCONTINENCE, Unable prevent bladder emptyng, Incontinence of urine NOS, [D]Incontinence of urine (context-dependent category), [D]Incontinence of urine NOS (context-dependent category), Unspecified urinary incontinence, Urine Incontinence, [D]Incontinence of urine, [D]Incontinence of urine NOS, Incontinence, unable to restrain urination, loss of control of urination (symptom), incontinent of urine, urinary loss of control, unable to restrain urination (symptom), loss of control of urination, [D]Incontinence of urine NOS (situation), [D]Incontinence of urine (situation), urinary incontinence, urinary incontinence (diagnosis), Incontinence urinary, Micturition involuntary, Urination involuntary, Urinary incontinence NOS, Urinary Incontinence [Disease/Finding], bladder incontinent, urine incontinent, leaking urine, Unable (to);hold urine, Incontinence;urine, Urination;involuntary, incontinent bladder, urinary incontinences, urine incontinence, bladder incontinence, loss of bladder control, bladder control loss, urine leak, urine leaking, weak bladder, Bladder incontinence, Incontinence of urine, Absence of bladder continence, Urinary incontinence, Involuntary urination, Lack of bladder control, Leaking of urine, Loss of bladder control, UI - Urinary incontinence, Unable to control bladder, Unable to hold fluids, Unable to hold urine, Unable to prevent bladder emptying, Weak bladder, Bladder: incontinent, Urine incontinence, Urinary incontinence (finding), Incontinence urine, bladder; weak, incontinence; urinary, urine; incontinence, weak; bladder, Bladder: incontinent (finding), Incontinence (Urinary), Urinary Incontinence, Urinary incontinence, unspecified, involuntary urination, unable to hold urine
French INCONTINENCE URINAIRE, Incontinence vésicale, Miction involontaire, Incontinence d'urine, Incontinence d'urine non précisée, Urination involontaire, INCONTINENCE D'URINE, INCONTINENCE VESICALE, MICTION INVOLONTAIRE, Incontinence urinaire
Portuguese INCONTINENCIA URINARIA, Incontinência vesical, Incontinência urinária NE, Micção involuntátia, Micção involuntária, INCONTINENCIA VESICAL, MICCAO INVOLUNTARIA, Incontinência urinária, Incontinência Urinária
Spanish INCONTINENCIA URINARIA, Incontinencia de orina, Incontinencia urinaria no especificada, Incontinencia vesical, Emisión involuntaria de orina, Micción involuntaria, [D]incontinencia urinaria (categoría dependiente del contexto), [D]incontinencia urinaria, SAI (categoría dependiente del contexto), [D]Incontinence of urine NOS, Bladder: incontinent, Urinary incontinence, [D]Incontinence of urine, DIURESIS INVOLUNTARIA, INCONTINENCIA VEJIGA URINARIA, MICCION INVOLUNTARIA, ORINA, INCONTINENCIA, [D]incontinencia urinaria, SAI, [D]incontinencia urinaria, SAI (situación), [D]incontinencia urinaria (situación), [D]incontinencia urinaria, ausencia de continencia urinaria, incontinencia de orina, incontinencia urinaria (hallazgo), incontinencia urinaria, incontinencia vesical, vejiga: incontinente (hallazgo), vejiga: incontinente, Incontinencia urinaria, Incontinencia Urinaria
German HARNINKONTINENZ, Blaseninkontinenz, Miktion unfreiwillig, unspezifische Harninkontinenz, Urinieren unfreiwillig, Urininkontinenz, BLASENINKONTINENZ, HARNABGANG UNKONTROLLIERT, MIKTION UNKONTROLLIERT, Nicht naeher bezeichnete Harninkontinenz, URININKONTINENZ, Harninkontinenz, Inkontinenz, Harn-
Dutch incontinentie urine, niet-specifieke urine-incontinentie, onvrijwillige urinelozing, urine incontinentie, onvrijwillige mictie, blaasincontinentie, blaas; zwak, incontinentie; urine, urine; incontinentie, zwak; blaas, Niet gespecificeerde urine-incontinentie, urine-incontinentie, Incontinentia urinae, Urine-incontinentie
Italian Incontinenza vescicale, Minzione involontaria, Incontinenza di urina, Incontinenza non specificata di urina, Incontinenza urinaria
Japanese 詳細不明の尿失禁, 膀胱性尿失禁, 不随意排尿, 尿失禁, ｼｮｳｻｲﾌﾒｲﾉﾆｮｳｼｯｷﾝ, ﾌｽﾞｲｲﾊｲﾆｮｳ, ﾎﾞｳｺｳｾｲﾆｮｳｼｯｷﾝ, ﾆｮｳｼｯｷﾝ
Swedish Urininkontinens
Czech moč - inkontinence, Blíže neurčená močová inkontinence, Inkontinence močového měchýře, Mimovolní močení, Močová inkontinence
Finnish Virtsankarkailu
Russian NEDERZHANIE MOCHI, НЕДЕРЖАНИЕ МОЧИ
Korean 상세불명의 요실금
Croatian URINARNA INKONTINENCIJA
Polish Nietrzymanie moczu
Hungarian Vizelet incontinentia, húgyúti incontinentia, Húgyhólyag incontinentia, Húgyúti incontinentia, Akaratlan vizeletürítés, Nem meghatározott vizeletincontinentia, Vizelet-incontinentia, Akaratlan vizelés
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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