Urinary Incontinence

Urinary Incontinence
By:Stephen J. Titus MD

Objectives
* Define the main causes of urinary incontinence.
* Formulate an approach to their diagnosis.
* Identify the treatment strategies for each.
* Remind each of us to not eat Yellow Snow

Impact
* Direct cost of treatment in 1995 was $26.3 billion
* More common in women then men
* >1/3 women >65 have some degree of incontinence
* Fewer than 50% will raise complaint to physician

Types of Urinary Incontinence
* Urge Incontinence
* Stress Incontinence
* Mixed Incontinence
* Overflow Incontinence
* Functional Incontinence
* Incontinence due to secondary causes
o Medications
o Urinary Tract Infections
o Stool Impaction
o Hyperglycemia
o Heart Failure
o Interstitial Cystitis
o Bladder Malignancies

Medications
* Diuretics
* Caffeine
* Alcohol
* Anticholinergics
* Alpha agonists
* Beta agonists
* Sedatives/Antidepressants/Antipsychotics
* Narcotics
* Alpha blockers
* ACE inhibitors(cough)
* Mixed
* Stress

Notre Dame
Evaluation
* History
* Physical
* Post Void Residual
* Laboratory
o Urinalysis (with culture if infection suspected)
o Renal function
o Fasting Glucose
* Urodynamic Testing

Venus de Milo
Treatment
* Urge Incontinence
* Stress Incontinence
* Mixed Incontinence
* Overflow Incontinence
* Functional Incontinence

Napolean’s Tomb
Cases
Summary
* Most cases of urinary incontinence can be diagnosed and initially treated with an H&P and routine labwork
* First line treatment for Urge, Stress and Mixed incontinence is behavioral and centered around Kegels
* Overflow: Think prostate in men, scar tissue /previous surgery in women.

Resources
Urinary Incontinence.ppt