Urinary Incontinence for NP
Urinary Incontinence for the Nurse Practitioner Licensing Exam
- Definition:
- Urinary incontinence is the involuntary leakage of urine. It is categorized into four types: stress, urge, overflow, and functional incontinence.
- Types of Urinary Incontinence:
- Stress Incontinence:
- Leakage occurs during activities that increase intra-abdominal pressure, such as coughing, sneezing, or physical exertion.
- Pathophysiology:
- Weakening of pelvic floor muscles or urethral sphincter incompetence, commonly due to pregnancy, childbirth, or menopause. In men, it can result from prostate surgery.
- Risk Factors:
- Vaginal delivery, aging, obesity, and pelvic surgery.
- Urge Incontinence:
- Characterized by a sudden and intense urge to void, followed by urine leakage.
- Pathophysiology:
- Detrusor overactivity, which may be idiopathic or secondary to neurological conditions (e.g., Parkinson’s disease, multiple sclerosis).
- Symptoms:
- Urgency, frequency, and nocturia.
- Overflow Incontinence:
- Results from chronic bladder overdistention due to incomplete bladder emptying, leading to continuous dribbling.
- Pathophysiology:
- Bladder outlet obstruction (e.g., benign prostatic hyperplasia [BPH]) or impaired detrusor muscle function (e.g., diabetic neuropathy).
- Functional Incontinence:
- Occurs when physical or cognitive impairments prevent timely access to a toilet, despite normal bladder function.
- Risk Factors:
- Dementia, arthritis, or mobility issues.
- Management:
- Lifestyle Modifications:
- Pelvic Floor Exercises:
- Recommended for stress incontinence to strengthen the pelvic muscles.
- Bladder Training:
- Effective for urge incontinence, with scheduled voiding to delay urination.
- Fluid Management:
- Reduce caffeine, alcohol, and excessive fluid intake to manage symptoms.
- Pharmacologic Therapy:
- Anticholinergics (e.g., oxybutynin, tolterodine) for urge incontinence to reduce detrusor overactivity.
- Beta-3 Agonists (mirabegron) as an alternative for urge incontinence.
- Alpha-Blockers (tamsulosin) for overflow incontinence due to BPH in men.
- Surgical Treatment:
- Midurethral Sling:
- Common for stress incontinence in women, providing support to the urethra.
- Transurethral Resection of the Prostate (TURP):
- For overflow incontinence due to BPH.
Key Points
- Urinary incontinence is classified as stress, urge, overflow, or functional, with mixed incontinence involving more than one type.
- First-line treatments include lifestyle modifications like pelvic floor exercises and bladder training.
- Pharmacologic therapy includes anticholinergics for urge incontinence and alpha-blockers for overflow incontinence.
- Surgical treatments, such as midurethral slings and TURP, are effective for stress and overflow incontinence.