Am I Incontinent Quiz: Urinary Incontinence Test with Flashcards

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Questions and Answers

Which of the following is NOT a reversible cause of urinary incontinence according to the text?

Bladder fistula (correct)

Decongestants

Alcohol

Pharmaceutical causes

What is example of one of the recommended first-line treatment for urinary incontinence based on the provided text?

Antihistamines

Pharmaceutical treatment

Timed void (correct)

Diuretics

When evaluating a patient with sudden or acute onset of severe urinary symptoms, what should always be considered as a potential source according to the text?

Atrophic vaginitis

Neurological source (correct)

Bladder irritants

Artificial sweeteners

What type of urinary incontinence is due to a temporary illness that can be reversed?

Transient incontinence Signup and view all the answers

Which of the following is NOT mentioned as a common pharmaceutical cause of reversible urinary incontinence?

Statins Signup and view all the answers

What type of treatment is ineffective for functional incontinence according to the text?

Pharmaceutical Therapies Signup and view all the answers

Which muscle overactivity is the cause of urge incontinence?

Detrusor muscle Signup and view all the answers

What are the common symptoms associated with an overactive bladder?

Urinary urgency, urinary frequency, and/or nocturia Signup and view all the answers

Which class of drugs is considered the first-line pharmaceutical treatment for urge incontinence?

Anticholinergics Signup and view all the answers

Why are anticholinergic drugs not recommended for patients with uncontrolled narrow-angle glaucoma?

They exacerbate glaucoma by increasing intraocular pressure Signup and view all the answers

Which category of medications can cause cognitive impairment in the elderly population?

Anticholinergics Signup and view all the answers

What is the first-line pharmaceutical treatment for urge incontinence that acts as a smooth muscle relaxer?

Beta-3 agonists Signup and view all the answers

Which second-line pharmaceutical therapy for urge incontinence increases the risk of urinary retention and/or UTIs?

Botox injections Signup and view all the answers

What is the grade for the use of anticholinergic drugs in pregnancy?

C Signup and view all the answers

What is a common risk factor for developing stress incontinence?

History of multiple vaginal deliveries Signup and view all the answers

Which type of surgery is considered the most effective and definitive treatment for stress incontinence?

Midurethral sling implementation Signup and view all the answers

Which population is more likely to develop stress incontinence according to the text?

Individuals with obesity Signup and view all the answers

Which medication has shown improvement in symptoms for stress incontinence but cannot be used in patients with tachyarrhythmias or hyperthyroidism?

Pseudoephedrine Signup and view all the answers

What is the main diagnostic criterion for identifying stress incontinence, besides patient history?

Leakage with coughing on a full bladder Signup and view all the answers

Which treatment modality for stress incontinence aims to improve pelvic muscle strength?

ALL of these Signup and view all the answers

Why are oral estrogens not recommended for women with urinary incontinence?

They worsen urinary incontinence Signup and view all the answers

Which class of drugs has been shown to worsen stress incontinence?

Alpha-adrenergic agonists (alfuzosin, doxazosin) Signup and view all the answers

Which medication has shown effectiveness in treating stress incontinence but has contraindications for patients with a history of withdrawal syndrome?

Cymbalta Signup and view all the answers

What type of surgery is considered the main surgical treatment for stress incontinence?

Tension-free vaginal tape (TVT) procedure Signup and view all the answers

Which of the following is a known side effect of alpha-adrenergic agonists used to manage stress incontinence?

Insomnia Signup and view all the answers

What lifestyle modification is recommended for managing stress incontinence?

Bladder training Signup and view all the answers

Stress incontinence can occur from:

coughing, sneezing, laughing, or standing up Signup and view all the answers

Stress incontinence is rare in men, except in the case of:

radical prostatectomy Signup and view all the answers

What is a common cause of overflow incontinence?

Decreased detrusor muscle activity Signup and view all the answers

What should be checked in patients with overflow incontinence and a post-residual volume greater than 350 mL?

Retention Signup and view all the answers

Which of the following is a treatment option for overflow incontinence?

5-alpha-reductase inhibitors Signup and view all the answers

What is a characteristic of patients with overflow incontinence regarding bladder emptying?

Incomplete bladder emptying Signup and view all the answers

In patients with acute obstruction and overflow incontinence, what initial intervention is recommended for decompression?

Catheterization Signup and view all the answers

When should a patient be referred to a specialist for possible urinary incontinence due to suspected vesicovaginal fistula?

History of pelvic reconstruction Signup and view all the answers

What should be considered when evaluating a patient with recurrent culture-proven UTIs?

Abdominal/pelvic pain in the absence of UTI Signup and view all the answers

What is an indicator for possible referral to a specialist in cases of urinary incontinence?

Persistently elevated post-void residual volume Signup and view all the answers

Which symptom, in addition to urinary incontinence, may trigger a referral to a specialist?

New neurologic symptoms Signup and view all the answers

What condition may prompt the need for referral to a specialist in cases of urinary incontinence?

Suspected overflow incontinence Signup and view all the answers

Which diagnostic finding indicates a cystocele?

Bulging mass from the vagina Signup and view all the answers

What is a common risk factor for developing a cystocele?

Multiple vaginal deliveries Signup and view all the answers

What is the definitive diagnosis for a urethral stricture?

Cystourethroscopy Signup and view all the answers

What initial test is often used to diagnose a urethral stricture?

Retrograde urethrogram (RUG) Signup and view all the answers

What is indicated if a patient with a urethral stricture has bothersome urinary complications?

Surgical reconstruction of the urethra Signup and view all the answers

Which surgical intervention is commonly performed for a cystocele?

Uterosacral ligament fixation Signup and view all the answers

What is a common symptom reported by patients with a cystocele?

Pelvic and/or vaginal fullness Signup and view all the answers

What is the main symptom that a patient with a Urethral Stricture is likely to complain about?

Weak stream of urine Signup and view all the answers

Which of the following conditions can lead to urethral stricture formation?

Penile fractures Signup and view all the answers

What is a common complication of urethral strictures?

Urinary retention Signup and view all the answers

How are cystoceles graded based on the text?

From 1 to 4 Signup and view all the answers

Which of the following is a common complaint in patients with a cystocele

Vaginal fullness Signup and view all the answers

What is considered the gold standard for the diagnosis and staging of bladder cancer?

Cystoscopy with biopsy Signup and view all the answers

Which population is at the greatest risk for bladder cancer?

White males Signup and view all the answers

What is the most common complaint associated with bladder cancer?

Painless gross or microscopic hematuria Signup and view all the answers

What is recommended for relief of symptoms in patients with interstitial cystitis?

Amitriptyline Signup and view all the answers

What is the main characteristic of interstitial cystitis?

Chronic bladder pain Signup and view all the answers

What is a major risk factor for bladder cancer?

Smoking Signup and view all the answers

Chronic indwelling catheters are indicated for Incomplete bladder emptying, Neurogenic bladder, Urethral stricture, Urinary Retention

True Signup and view all the answers

Study Notes

Urinary Incontinence

Defined as the involuntary loss of urine
Reversible causes include: infection, atrophic vaginitis, bladder irritants, and pharmaceutical causes
Common pharmaceutical causes: antihistamines, decongestants, benzodiazepines, opioids, diuretics, alpha-blockers, and anti-arrhythmic

Urge Incontinence (OAB)

Defined as the leakage of urine preceded by a strong urge to void with the inability to delay urination
Caused by the overactivity of the detrusor muscle
Symptoms: urinary urgency, frequency, and/or nocturia
First-line treatment: non-pharmaceutical lifestyle modifications and pelvic floor physical therapy
Pharmaceutical treatment: anticholinergic drugs (e.g. oxybutynin) and beta-3 agonists (e.g. mirabegron)
Anticholinergic drugs: adverse effects include dry mouth, constipation, blurred vision, tachycardia, and orthostatic hypotension

Stress Incontinence

Defined as urinary leakage secondary to increased intra-abdominal pressure
Causes: laxity of the pelvic floor muscles
Risk factors: obesity, multiple vaginal deliveries, and radical prostatectomy in men
Diagnosis: patient history and physical exam findings of urine leakage with coughing on a full bladder
Treatment: lifestyle modifications, pelvic floor physical therapy, insertable devices (e.g. pessaries), and surgery (midurethral sling)

Overflow Incontinence

Defined as urinary incontinence due to urinary retention leading to incomplete bladder emptying
Causes: underactive bladder, decreased detrusor muscle activity, bladder outlet obstructions (e.g. BPH or urethral stricture)
Treatment: dependent on pathology, may include catheterization, 5-alpha-reductase inhibitors, and alpha-1 adrenergic blockers

Referral to a Specialist

Indications for referral: suspected surgical candidate for SUI, associated abdominal/pelvic pain, recurrent UTI, gross/microscopic hematuria, and suspected overflow incontinence

Pelvic Organ Prolapse - Cystocele

Defined as the posterior bladder herniating into the anterior vagina
Risk factors: weakness in pelvic floor, increased pelvic floor pressure, multiple vaginal deliveries, obesity, age, and menopause
Symptoms: pelvic and/or vaginal fullness
Diagnosis: physical exam findings of a bulging mass from the vagina with increased abdominal pressure
Treatment: pelvic floor therapy, pessaries, topical estrogen, or surgical interventions (e.g. hysterectomy, uterosacral/sacrospinous ligament fixation)

Urethral Stricture

Defined as a narrowing or complete blockage of the urethra secondary to scar tissue formation
Causes: traumatic injuries, penile fractures, catheters, UTIs
Symptoms: weak stream, urinary dribbling, urinary spraying, or a split urinary stream
Diagnosis: retrograde urethrogram (RUG) or cystourethroscopy
Treatment: minimally invasive dilations, urinary diversion with tubes, or surgical reconstruction of the urethra

Bladder Cancer

Risk factors: smoking, white males
Most common complaint: painless gross or microscopic hematuria
Diagnosis: cystoscopy with biopsy
Treatment: transurethral resection of the bladder tumor (TURBT) for early-stage tumors

Interstitial Cystitis

Defined as chronic bladder pain in the absence of other explanatory etiologies
Symptoms: greater than 6 weeks of pain and discomfort related to bladder filling, but relieved with bladder emptying
Treatment: Amitriptyline for symptom relief, no curative treatment

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Description

Test your knowledge on reversible causes of urinary incontinence, including infections, atrophic vaginitis, bladder irritants, and common pharmaceuticals that can lead to this condition. Explore the factors that can contribute to involuntary loss of urine.

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