View source for Archive:Urinary Incontinence

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=='''Types of incontinence'''==
{| border=1 cellspacing=0 cellpadding=5
|'''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
|}


==HPI:== 
===Timing===
*When: day/night
*Duration
*Flow
*Activity
*Intermittent/constant
*New or ongoing

===Urinary Sx===
*Dysuria
*abnormal urine
*hesitancy
*urgency
*quality of stream
*volume 
*aware of urine loss
*relieving/aggrevating factors
*post void dribble

===Systemic===
*fever
*polydipsea
*decreased perineal sensation
*stool incontinence

==PMHx==
===Medical===
*Cancer
*Diabetes
*Stones
*CVA/Parkinson's/Dementia
*hypercalcemia (exhibits polyurea and polydipsea)
*prostatic hypertrophy

===Surgical===
*Vaginal/pelvic
*prostate

===Gyne===
*Gestation/Parity


==Medications==
*Sedatives
*Tranquilizers
*anticholinergics
*symptomatic blockers
*diuretics

==Family history==
*any similar problems in family?

==Social history==
*Function at home
*restricted mobility
*employment
*EtOH
*Caffiene
*smoking


==Review of systems==
*endocrine
**menopause/atrophic vaginitis
*neuro
**sensory or motor changes?
*GI
**constipation/diarrhea

==Etiology==
*DRIP
**'''D'''ementia/Delerium
**'''R'''estricted mobility
**'''I'''nfection
**'''P'''harmacy

==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

==Other OSCE modules==
{{OSCE2}}
[[Category:OSCE]]