Archive:Urinary Incontinence

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

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
  • Dementia/Delerium
  • Restricted mobility
  • Infection
  • Pharmacy

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

Observed structured clinical examination

Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence