Urinary Incontinence
Types of incontinence
[edit | edit source]| 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 bladder
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 |
HPI:
[edit | edit source]Timing
[edit | edit source]- When: day/night
- Duration
- Flow
- Activity
- Intermittent/constant
- New or ongoing
Urinary Sx
[edit | edit source]- Dysuria
- abnormal urine
- hesitancy
- urgency
- quality of stream
- volume
- aware of urine loss
- relieving/aggrevating factors
- post void dribble
Systemic
[edit | edit source]- fever
- polydipsea
- decreased perineal sensation
- stool incontinence
PMHx
[edit | edit source]Medical
[edit | edit source]- Cancer
- Diabetes
- Stones
- CVA/Parkinson's/Dementia
- hypercalcemia (exhibits polyurea and polydipsea)
- prostatic hypertrophy
Surgical
[edit | edit source]- Vaginal/pelvic
- prostate
Gyne
[edit | edit source]- Gestation/Parity
Medications
[edit | edit source]- Sedatives
- Tranquilizers
- anticholinergics
- Sympathetic blockers
- diuretics
Family history
[edit | edit source]- any similar problems in family?
Social history
[edit | edit source]- Function at home
- restricted mobility
- employment
- EtOH
- Caffiene
- smoking
Review of systems
[edit | edit source]- endocrine
- menopause/atrophic vaginitis
- neuro
- sensory or motor changes?
- GI
- constipation/diarrhea
Etiology
[edit | edit source]- DRIP
- Dementia/Delerium
- Restricted mobility
- Infection
- Pharmacy
Treatable causes of urinary incontinence
[edit | edit source]- 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