Urinary Incontinence

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Contents 1 Types of incontinence 2 HPI: 2.1 Timing 2.2 Urinary Sx 2.3 Systemic 3 PMHx 3.1 Medical 3.2 Surgical 3.3 Gyne 4 Medications 5 Family history 6 Social history 7 Review of systems 8 Etiology 9 Treatable causes of urinary incontinence 10 Other OSCE modules

[edit] Types of incontinence

Type	Mechanism	Symptoms	Signs	Treatment
stress	abdominal pressure against a weakened urethral sphincter	momentary leak with a small amount lost with sneezing laughing, etc.	nonpalpable bladder, atrophy and incontinence	kegel excercises, pessary, consult urology/gyne
urge	decreased detrusor contraction increasing of sensory pathways deconditioned voiding reflex	urge to void moderate volume nocturia dysuria	nonpalpable bladder signs of CNS disease fecal impaction	decreased night fluids pads retrain bladder with regular toileting
overflow	poor detruser control outlet obstruction (ie BPH) decreased bladder sensation	continuous dribble decreased stream force urinary obstruction	large tender bladd large prostate decreased perineal sensation decreased anal reflex motor disease	catheter consult urology for bladder dynamics
functional	decreased mobility or environmental	incontinent on way to bathroom or in early morning	non palpable bladder	improve mobility change environment
true	fistula ectopic ureteric orifice	constant dribble small amount of urine	urine from vagina or ectomic orifice	surgery
post void dribble	psychogenic prostatitis obstruction

[edit] HPI:

[edit] Timing

• When: day/night
• Duration
• Flow
• Activity
• Intermittent/constant
• New or ongoing

[edit] Urinary Sx

• Dysuria
• abnormal urine
• hesitancy
• urgency
• quality of stream
• volume
• aware of urine loss
• relieving/aggrevating factors
• post void dribble

[edit] Systemic

• fever
• polydipsea
• decreased perineal sensation
• stool incontinence

[edit] PMHx

[edit] Medical

• Cancer
• Diabetes
• Stones
• CVA/Parkinson's/Dementia
• hypercalcemia (exhibits polyurea and polydipsea)
• prostatic hypertrophy

[edit] Surgical

• Vaginal/pelvic
• prostate

[edit] Gyne

• Gestation/Parity

[edit] Medications

• Sedatives
• Tranquilizers
• anticholinergics
• symptomatic blockers
• diuretics

[edit] Family history

• any similar problems in family?

[edit] Social history

• Function at home
• restricted mobility
• employment
• EtOH
• Caffiene
• smoking

[edit] Review of systems

• endocrine
  • menopause/atrophic vaginitis
• neuro
  • sensory or motor changes?
• GI
  • constipation/diarrhea

[edit] Etiology

• DRIP
  • Dementia/Delerium
  • Restricted mobility
  • Infection
  • Pharmacy

[edit] Treatable causes of urinary incontinence

• D elirium
• I nfection--urinary (symptomatic)
• A trophic urethritis and vaginitis
• P harmaceuticals
• P sychologic disorders, especially depression
• E xcessive urine output (eg, from heart failure or hyperglycemia)
• R estricted mobility
• S tool impaction

[edit] Other OSCE modules