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10/11/2016 1 Urinary Incontinence for the Primary Care Provider
Diana J Scott FNP-BC
https://youtu.be/gMzAUE1OJn4
Urinary Incontinence for the Primary Care Provider Diana J Scott - - PDF document
Urinary Incontinence for the Primary Care Provider Diana J Scott - - PDF document
10/11/2016 Urinary Incontinence for the Primary Care Provider Diana J Scott FNP-BC https://youtu.be/gMzAUE1OJn4 1 10/11/2016 Assessment of Urinary Incontinence Urge Stress Mixed Other overflow, postural, continuous,
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Assessment Points, cont’d
Suspicious symptoms
Hematuria, dysuria
Consider a Volume Chart/Bladder Diary
Three days, record the time they get up and time to bed, fluid intake, volume of urine passed each time voiding, every episode of incontinence and use of incontinence pads
Bladder Diary
Date/ Time Liquid Intake Urine Volume Leaks Pad Change
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Physical Exam
A pelvic exam is not optional
Atrophic vaginitis Skin breakdown Urethral caruncle or prolapse Pelvic organ prolapse
Prostate exam for men Consider cathing for PVR
Urinalysis
Start with dipstick
Blood‐send for UA for RBC count Leukocytes‐culture Nitrites‐culture
Stress Incontinence
Defect in urethral support
Predisposing factors include obesity, constipation, parity Commonly associated with pelvic
- rgan prolapse
Leakage with cough or valsalva on pelvic exam, urethral hypermobility
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Treatment for SUI
Pelvic floor physiotherapy
Often needs formal referral, not just self Kegels Topical estrogen Referral to specialty for
Bulking agents, urethral support surgery (sling) Pessary
Overactive Bladder/Urge Incontinence
OAB may present with or without incontinence Urgency Frequency ‐ >8 times in 24 hours Nocturia
OAB/Urge Incontinence Treatment
Lifestyle modification Behavioral therapy Pharmacologic options
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Realistic Expectations
Discuss with your patient what their realistic goal is. OAB can generally be improved, but not cured
Medications
Two choices, antimuscarinic or beta3 agonist Data does not show a statistically significant difference in effectiveness between these medications Studies have shown fewer side effects with oxybutynin XL, tolterodine LA,
- xytrol, trospium, solifenacin, and
darifenacin.
OAB/Urge Incontinence Medications
All but Myrbetriq contraindicated in uncontrolled narrow angle glaucoma Myrbetriq contraindicated in uncontrolled hypertension
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OAB/Urge Incontinence Medications
Oxybutynin (Ditropan, Oxytrol, Gelniq) Tolterodine (Detrol) Trospium (Sanctura) Fesoterodine (Toviaz) Solifenacin (Vesicare) Darifenacin (Enablex) Mirabegron (Myrbetriq)
Other Types
Mixed Overflow – BPH, neurogenic bladder
Referral
Concerning symptoms – hematuria, bladder pain Uncertainty of diagnosis Treatment failure Everyone with MS and with spinal cord injury with any bladder symptoms at all
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References
- International Continence Society Fact Sheets, Assessment of Lower Urinary
Tract Symptoms, Publications & Communications Committee 2015 Aug, pp 4- 6, can be read online at: www.ics.org/Documents/Documents.aspx?DocumentID=3102
- Pelvic floor muscle training versus no treatment for urinary incontinence in
- women. A Cochrane systematic review. Dumoulin C, Hay-Smith J, Eur J Phys
Rehabil Med. 2008 Mar;44(1):47-63.
- Kirchin V, Page T, Keegan PE, et al. Urethral injection therapy for urinary
incontinence in women. Cochrane Database Syst Rev 2012;2:CD003881. Review.
- Andersson KE, Chapple CR, Cardozo L, et al. Pharmacological treatment of
urinary incontinence. In: Abrams P, Cardozo L, Khoury S, Wein A, editors.
- Incontinence. 4th International Consultation on Incontinence ed. Paris: Health
Publication Ltd.; 2009. PP. 631-700.
- Bosch JL, Weiss JP. The prevalence and causes of nocturia. J. Urol. 2010;
184(2); 440-6.
- Marinkovic SP, Rovner ES, Moldwin RM, et al. The management of overactive
bladder syndrome. BMJ 2012;344:e2365. Review.
- Epstein BJ, Gums JG, Molina E. Newer agents for the management of
- veractive bladder. Am Fam Physician. 2006 Dec 15: 74(12): 2061-2068.