geriatrics : ui dr. meg-angela christi amores. urinary incontinence major problem for older adults,...
TRANSCRIPT
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GERIATRICS : UI
Dr. Meg-angela Christi Amores
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URINARY INCONTINENCE
major problem for older adults, afflicting up to 30% of community-dwelling elders and 50% of nursing home residents
affects women twice as commonly as men at ages <80 yo
>80 yo, sexes are equally affected
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Risk factors
Advanced age functional impairment Dementia Obesity Smoking affective disorder Constipation certain medical illnesses (such as chronic
obstructive pulmonary disease and heart failure), history of pelvic surgery
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DRIIIPP
Reversible Conditions Associated with Urinary Incontinence
Delirium
Restricted mobility—illness, injury, gait disorder, restraint
Infection—acute, symptomatic urinary tract infection
Inflammation—atrophic vaginitis
Impaction—of feces
Polyuria—diabetes, caffeine intake, volume overload
Pharmaceuticals—diuretics, -adrenergic agonists or antagonists, anticholinergic agents (psychotropics, antidepressants, anti-Parkinsonians)
Source: After DB Reuben et al.
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Stress Incontinence
results when the urethral sphincter mechanisms are inadequate to hold urine during bladder filling
leaking small amounts of urine during activities that increase intraabdominal pressure: coughing, laughing, sneezing, lifting, or standing up
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Stress Incontinence
most common causes of stress incontinence in women are insufficient pelvic support due to childbearing, gynecologic surgery, and the decreased effects of estrogen on tissues of the lower urinary tract
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Diagnosis and treatment
History Stress test
Surgical intervention Pelvic muscle exercise
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Urge Incontinence
detrusor overactivity (DO) characterized by uninhibited bladder
contractions and is the most common form of UI in older adults
Described by patients as: uncontrollable need to void
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Urge incontinence
Urinary frequency and nocturnal incontinence
particularly accompanied by loss of larger urine volumes (>100 mL)
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Etiology – urge incontinence
may be idiopathic, associated with lesions of the central nervous system, such as a stroke, or be due to bladder irritation from infection, stones, or tumors
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Diagnosis – urge incontinence Measurement of postvoid residual (PVR)
should be part of an incontinence evaluation in all patients
the patient's bladder is catheterized 5–10 min after the patient has voided
PVR > 200 mL suggests detrusor underactivity or obstruction
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Treatment – urge incontinence bladder retraining by encouraging the
patient to void every 2 hours try urgency control by sitting or standing
quietly while focusing on allowing the urgency to pass before slowly walking to the bathroom
anticholinergic drugs, oxybutinin and tolterodine, which cause bladder relaxation
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Mixed Incontinence
refers to UI where symptoms of both stress and urge incontinence are present
three incontinence questions (3IQ) Q1: if the patient has leaked urine in the
past 3 months Q2: familiarizes patients with types of
incontinence: stress, urge, or other Q3: category of incontinence based on
her symptoms during the past 3 months
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Overflow Incontinence
due to either bladder outlet obstruction or an atonic bladder
Male patients, but rarely females, may complain of dribbling after voiding
an incessant urge to urinate, or straining to urinate
palpable distended bladder
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Etiology – overflow incontinence Prostatic hypertrophy, prostate cancer,
and urethral strictures cystocele can cause this problem in
women spinal cord disease, autonomic
neuropathy of diabetes, alcoholism, vitamin B12 deficiency, Parkinson's disease, tabes dorsalis, or chronic outlet obstruction
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Diagnosis and treatment – overflow incontinence
Urodynamic testing distinguishing urethral obstruction from
detrusor underactivity For obstruction: surgical removal of the
obstruction BPH: terazosin, doxazosin, or tamulosin