Urinary Incontinence

## Contents

* 1 Types of incontinence
* 2 HPI:
* 2.1 Timing
* 2.2 Urinary Sx
* 2.3 Systemic
* 3 PMHx
* 3.1 Medical
* 3.2 Surgical
* 3.3 Gyne
* 4 Medications
* 5 Family history
* 6 Social history
* 7 Review of systems
* 8 Etiology
* 9 Treatable causes of urinary incontinence
* 10 Other OSCE modules

## Types of incontinence

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Type | Mechanism | Symptoms | Signs | Treatment

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|
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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 bladder

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:

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### Timing

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

### Urinary Sx

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

### Systemic

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* fever
* polydipsea
* decreased perineal sensation
* stool incontinence

## PMHx

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### Medical

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

### Surgical

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* Vaginal/pelvic
* prostate

### Gyne

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* Gestation/Parity

## Medications

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* Sedatives
* Tranquilizers
* anticholinergics
* Sympathetic blockers
* diuretics

## Family history

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* any similar problems in family?

## Social history

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* Function at home
* restricted mobility
* employment
* EtOH
* Caffiene
* smoking

## Review of systems

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* endocrine
* menopause/atrophic vaginitis
* neuro
* sensory or motor changes?
* GI
* constipation/diarrhea

## Etiology

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* DRIP
* Dementia/Delerium
* Restricted mobility
* Infection
* Pharmacy

## Treatable causes of urinary incontinence

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* 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

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* v
* t
* e

Objective 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
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