INCONTINENCE

• Loss of small amounts of urine during coughing, laughing, or other activities which increase intra-abdominal pressure;
  
• Due to weak pelvic floor and urethra muscles;
  
• Detrusor instability;
• Predominantly found in women; treatable; Kegel’s exercise

• Leakage of large amounts of urine precipitated by involuntary bladder contractions;
  
• Inability to delay voiding once a sensation of bladder fullness is perceived;
  
• Due to various GU and CNS conditions that cause hyper-reflexia of bladder contractions (Urethritis, cystitis, stones, stoke, spinal cord injury, MS, Parkinson's, Alzheimer's, tumors);
  
• treatable; Have to train patients not to jump up and go to bathroom because increases intra-abdominal pressure - patient needs to focus on pelvic floor contraction and then wait till contractions diminish and then get up and go to the bathroom

• Overflow, paradoxical, and neurogenic
  
• Constant dribbling of small amounts of urine;
  
• Due to overdistention of the bladder;
• Causes include: Anatomic obstruction, Hypocontractile bladder, Use of certain medications;
  
• palpable or percussive bladder

• Involuntary loss of urine resulting from inability to use a toilet;
  
• May be caused by physical, psychological, or environmental factors;
  
• Occurs despite normal urinary tract function (patients with broken legs, spinal surgery, depression, etc.)
  
• Patient is depressed first and then express depression with functional incontinence - in all other incontinences, the incontinence was first which lead to depression

• Combinations of the four previous categories;
  
• M/C combo: stress and urge incontinence;
  
• Identifying presence of >1 type important for treatment options

• Biofeedback Methods- Monitoring pelvic floor muscles and contraction of external urethral sphincter through reinforcement with visual and auditory signals;
  
• Kegel's exercises: drawing in anal and vaginal sphincters as if to control urination or defecation, W/O contracting abdominal, buttock, or inner thigh muscles;
  
• Habit Retraining- Scheduled voiding ("bladder drills") can alter detrusor activity;
  
• Electrical stimulation and reflex techniques- Stimulate nerves in perineal floor, Relax bladder, - Mechanisms are not clear

Category: Nephrology Notes