Urinary Incontinence for USMLE

Handwritten lecture on urinary incontinence for medical students studying for the USMLE. In particular stress incontinence, urge incontince, overflow incontinence and neuropathic incontinence. Reviewing Anatomy, Physiology, Pathophysiology, Causes, Symptoms, and Management.
PATHOLOGY
Definition of Urinary Continence is the involuntary leakage of urine. Areas of problems can be increased contraction of detrusor muscle known as urge incontinence or too much relaxation of sphincters which is overflow incontinence. Any damage to nerves leading to neurogenic bladder.
ETIOLOGY AND CAUSES
Transient causes have a nice mnemonic - DIAPPERS
Delirium - acute confusion
Infections - UTI
Atrophic vaginitis
Psychological
Excessive Urine - drinking too much fluids
Restricted mobility
Stool impaction
Drugs that may cause temporary urinary incontinence
Anti-cholinergics, anti-psychotics, anti-parkinsons, alpha agonist or alpha antagonist, Diuretics and ACE inhibitors. Calcium Channel Blockers, Sedative and Hypnotics.
INVESTIGATIONS
In the emergency room you must rule out cauda equina or cord compression. These will require MRI/CT and this is the only time you would want to do MRI/CT for urinary incontinence. Urinalysis and culture can rule out UTI. Urine cytology also helps rule out bladder cancer. Renal Function Tests are important because pathology may affect the renal function. Urodynamic studies such as uroflow studies (pressure in the bladder to the flow in urine). Postvoidal residual volume (amount of urine available after urinary and this may be done by ultrasound or catheter). Bladder complance showing how much bladder can hold. Cystourethroscopy is putting a camera into the bladder.
STRESS INCONTINENCE
Leakage with increased abdominal pressure such as cough or sneeze. Will have this classic presentation. In men the main cause is surgery (TURP) for prostate cancer. In women the causes are related to hypermobility of the sphincter since the external sphincter moves lower (usually because of vaginal delivery) and when the levator ani contracts with abdominal muscle and this can no longer occur since the levator ani is no longer surrounding the external sphincter. Sphincter deficiency is cuased by atrophy of vagina in postmenopausal women. Tend to improve with Estrogen.
Inveatigations - Pad test is used to weight for 1hr or 24 hour to see how much is leaking. Cough Test - fill bladder and ask patient to cough and look for urine. Q Tip test consists of putting a Q-tip and ask patient to rest and strain. If Q Tip moves greater than 30 degrees then the patient has a hypermobile sphincter. Urodynamic testing may show low urethral pressure
Treatment consist of weight loss, diet and Kiegle Exercises. Duloxetin (SNRI) can help symptoms. There are also surgical procedures.
URGE INCONTINENCE
Sudden feeling of urgency and before they make it to the bathroom they urinate on themselves.Due to detrosur overactivity and high sensitivity. Overactive bladder is they have urgency, frequency and may never have urge incontinence. Decrease bladder compliance. Causes consist of neurogenic causes, myogenic causes because of hypersensitive muscles. And idiopathic caueses.
Treatment consists o bladder trianing to increase capacity. Hold urine to get bladder used to increase capacity. Public muscle training and relaxation of detrusor muscle. Fluid management to control how much water they drink. Dietary changes to decrease spicy food and citrus foods. Oxybutinin and botulinum to relax the sphincters.
MIXED INCONTINENCE
Patients have stress and urge incontinence.
OVERFLOW INCONTINENCE
Bladder distention due to detrusor or sphincter problem. Bladder outlet obstruction sch as BPH, neck contraction, urethral stricture, cystocele, pelvic organ prolapse. Decreased detrusor contraction by medications that decrease detrusor contraciton. Spinal lesions and long standing overdistention weakening muscles.
Investigations to perform are postvoid residual volume measure amount of urine in bladder after voiding by ultrasound, catheter. Normal is less than 50mL and greater than 200mL is diagnostic. Anything in the middle is gray area.
Treatment is to treat underlying cause if obstructive. Non-obstructive can be treated with Chronic Intermittent catheterization.
NEUROPATHIC INCONTINENCE
Due to lesions in brain, spine or peripheral nerve. Caused by strokes, trauma, aneurysms, hemmorrhage, MS. Spinal cord lesion and cauda syndrome. May cause decrease compliance by have high bladder pressure at low filling rates causing quick leaking. Common in meninomyelocele and Upper motor Neurons. Loss of sphincter tone by cauda equina, and open external sphincter.
Investigations consists of neurologic, urodynamic, CT, MRI, and EMG.
Treatment consists of increasing compliance with anti-cholinergics oxybutinin, imipramine, botulinum. Sphincter can be used with pessary to block the sphincter and when ready urinate the cork can be removed.

[@rehemanzilani5816]

here's a few ideas for relieving incontinence quickly Try Kegel exercises- which involve flexing the same muscles you use to stop the urinary flow. Use losing weight if you are overweight excess belly fat puts pressure on the bladder and the pelvic muscles. Shedding a few pounds if you are overweight can help restore your bladder control. See if you can train your bladder - put off going to bathroom. Try to delay urinating by 10 minutes and build up to 20 minutes etc.

[@tundeoladosu3206]

this is very helpful, thanks doc!

[@nabdullah8213]

may god bless you for your great simplfied videoes ...

[@asadhillis]

thank you for this nice clear informative presentation

[@DrAlpha-ek7go]

The sympathetic receptor is beta-3

[@yorlett5888]

There are a few ideas for ways to treat bladder control issues - Try Kegel exercises- which involve flexing the same muscles you use to stop the urinary flow. Use losing weight if you are overweight excess belly fat puts pressure on the bladder and the pelvic muscles. Shedding a few pounds if you are overweight can help restore your bladder control. Try to train your bladder - put off going to bathroom. Try to delay urinating by 10 minutes and build up to 20 minutes etc. Try magnesium and vitamin D Try Quiting smoking. Nicotine can irritate the bladder. (I read these and the reasons they work from Nilah control plan site )

[@nargishperveen3216]

This vedio makes the Urinary incontinence Easy to understand, Thanks a lot

[@thestudyspot]

+Nargish Perveen Great! Glad I could make that easier for you.

[@nabilsalim3864]

There are several ideas for relieving bladder control issues quickly : Try Kegel exercises- which involve flexing the same muscles you use to stop the urinary flow. Use losing weight if you are overweight excess belly fat puts pressure on the bladder and the pelvic muscles. Shedding a few pounds if you are overweight can help restore your bladder control. Try to train your bladder - put off going to bathroom. Try to delay urinating by 10 minutes and build up to 20 minutes etc. Use magnesium and vitamin D Use Quiting smoking. Nicotine can irritate the bladder. (I learned these and why they work from Nilah control plan website )

[@rimalkawas6730]

Love it... Thank you a lot :)

[@adnanmalik6390]

great man you rock

[@immadisarojini2775]

Super concept

[@cathum]

This is the info that I couldn’t find anywhere - thanks so much; just curious about tamsulosin, not mentioned in the treatment.

[@auzrealmwid]

acts on alpha1 receptor as an antagonist, thus relaxing the internal sphincter

[@ShashankChaganty]

External sphincter is found in deep peroneal pouch and not in pelvic diaphragm

[@shirtsguitar]

Tysm 😁

[@lisahartz8598]

Great discussion! This material is very close to the test content I have tomorrow for my continence nursing specialty at the Cleveland Clinic

[@thestudyspot]

Lisa Hartz Hope you do well!

[@sindoora1]

You mention that anti-cholinergic drugs are a cause for incontinence due to detrusor muscle contraction but surely it will cause relaxation as it is inhibiting the parasympathetic. Plus, arent anti-muscarinic drugs used for the treatment of detrusor overactivity?

[@dinaash5673]

Sindoora J you’re right

[@raghadalotaibi2869]

Up you are right

[@pandurangrotithor]

How the bladder neck elevation( mid uretra) stops leak

[@AshwaniKumar-hu7wv]

Kya spinchter repair ho Sakti hai

[@hozefa18]

Thank you :)

[@thestudyspot]

+Hozefa hussain Your Welcome

[@cmetube]

What were the primary textbook sources you used to make this, if I want to read more about the mechanism of action? Can you please list the sources?

[@SamedAsmer]

CIC = clean intermittent catheterization, not chronic

[@sarah5578]

9:12 did you mean to say sympathetic NS inactivation instead of activation?

[@toidymat3320]

Great Information, Thank You! Steve at ToidyMat

[@jimdwight558]

This video has great information about Stress Incontinence. If you want to know more, check out the below video. Hope it will help 😃 👍 👍 kzbin.info/www/bejne/gZfMaX6nfrlkZqM

[@jamessims9475]

awesome

[@asemkwabena6587]

There are a few factors in treating incontinence at home. One resource I discovered which succeeds in merging these is the Nilah control plan (check it out on google) it's the most helpful blueprint i've seen. Check out all the incredible information .

[@abdurrehmancheema4144]

anticholinergic prevent relaxation of bladder, is it correct?

[@ashitoshkulkarni8569]

Ha yr mai to itna pareshan tha is problem se ki muze to urin control hi nhi hoti thi bathroom jane tak mere kapde gile ho jate the,, are sare homeopathy, english dava, jo logone bola oo try kiya kuchh fark hi nhi pada ..fir ayurvedic utracon syrup use kiya amazone se mngavaya tha.. bs isse mera 5 sal purana problem khatm hi hogaya ///

[@ashitoshkulkarni8569]

Ha yr mai to itna pareshan tha is problem se ki muze to urin control hi nhi hoti thi bathroom jane tak mere kapde gile ho jate the,, are sare homeopathy, english dava, jo logone bola oo try kiya kuchh fark hi nhi pada ..fir ayurvedic utracon syrup use kiya amazone se mngavaya tha.. bs isse mera 5 sal purana problem khatm hi hogaya ///

[@adorable3006]

There are several factors in treating bladder control issues at home. One resource I found which successfully combines these is the Nilah control plan (google it if you're interested) it's the most incredible resource that I've heard of. Check out the incredible information .

[@alinawani2507]

Sir anticholinergics are used for urinary incontinence?

[@shanayakapoor8355]

Ji ye same problem muze bhi thi bohot pareshan ho gayi thi mai bilkul bhi fresh feel nhi kar rahi thi jalan ,khujli ,infection ki vajah se bohot kaisa to bi lagta tha maine ye youtube pe bohot videos dekh kr try bhi kiya pr fayda nhi huaa kisi upchar se fir youtube pe hi UTRACON syrup k bare me tha to ye try kiya bs isse hi muze bohot jald aram huaa hai ,,ab mai bohot achha feel krti hu ab bilkul infection nhi hai ,,comment me hi ek ladkise baat huyi thi to unhone hi bataya tha ki ye amazone se milega to maine order kr liya tha and ye ayurvedic bhi hai*

[@ashitoshkulkarni8569]

@@shanayakapoor8355 mai bhi kya kuchh try kiya tha pr muze bhi sirf utracon syrup se hi fyda huaa :::

[@shanayakapoor8355]

Ji ye same problem muze bhi thi bohot pareshan ho gayi thi mai bilkul bhi fresh feel nhi kar rahi thi jalan ,khujli ,infection ki vajah se bohot kaisa to bi lagta tha maine ye youtube pe bohot videos dekh kr try bhi kiya pr fayda nhi huaa kisi upchar se fir youtube pe hi UTRACON syrup k bare me tha to ye try kiya bs isse hi muze bohot jald aram huaa hai ,,ab mai bohot achha feel krti hu ab bilkul infection nhi hai ,,comment me hi ek ladkise baat huyi thi to unhone hi bataya tha ki ye amazone se milega to maine order kr liya tha and ye ayurvedic bhi hai.

[@ashitoshkulkarni8569]

Mai bhi kya kuchh try kiya tha pr muze bhi sirf utracon syrup se hi fayda huaa hai ***

[@nikitakhazov2403]

*beta3, pudendal nerve

[@drdhirajrajregmi]

Its b3 rather than b2 .

[@tirthvirani2206]

neuropathic is not a different type...it is a cause of either urge or overflow incontinence...

[@shanayakapoor8355]

Ji ye same problem muze bhi thi bohot pareshan ho gayi thi mai bilkul bhi fresh feel nhi kar rahi thi jalan ,khujli ,infection ki vajah se bohot kaisa to bi lagta tha maine ye youtube pe bohot videos dekh kr try bhi kiya pr fayda nhi huaa kisi upchar se fir youtube pe hi UTRACON syrup k bare me tha to ye try kiya bs isse hi muze bohot jald aram huaa hai ,,ab mai bohot achha feel krti hu ab bilkul infection nhi hai ,,comment me hi ek ladkise baat huyi thi to unhone hi bataya tha ki ye amazone se milega to maine order kr liya tha and ye ayurvedic bhi hai"