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URINARY INCONTINENCE

Slide 3. TOPICS COVERED. Prevalence and Impact of Incontinence Normal MicturitionAge-related Changes, Risk Factors, and Medical Conditions Associated with UITypes of Urinary IncontinenceAssessment: History, Physical Exam, TestingManagement StrategiesCatheters and Catheter Care. Slide 24. COMPONENTS OF COMPREHENSIVE ASSESSMENT OF UI.

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URINARY INCONTINENCE

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    1. URINARY INCONTINENCE Suggestions for Lecturer -1-hour lecture -Use GRS slides alone or to supplement own your teaching materials. -Refer to GRS for further content. -Refer to Geriatrics At Your Fingertips for updated information on patient evaluation and management. -Supplement lecture with handouts, eg, a sample bladder diary. -See GRS7 questions 48, 56, 61, 113, 179, 205, 239, and 286 for additional case vignettes on urinary incontinence. Suggestions for Lecturer -1-hour lecture -Use GRS slides alone or to supplement own your teaching materials. -Refer to GRS for further content. -Refer to Geriatrics At Your Fingertips for updated information on patient evaluation and management. -Supplement lecture with handouts, eg, a sample bladder diary. -See GRS7 questions 48, 56, 61, 113, 179, 205, 239, and 286 for additional case vignettes on urinary incontinence.

    2. Slide 3 TOPICS COVERED Prevalence and Impact of Incontinence Normal Micturition Age-related Changes, Risk Factors, and Medical Conditions Associated with UI Types of Urinary Incontinence Assessment: History, Physical Exam, Testing Management Strategies Catheters and Catheter Care

    3. Slide 24 COMPONENTS OF COMPREHENSIVE ASSESSMENT OF UI History: including quality of life Physical examination: include cardiovascular, abdominal, musculoskeletal, neurologic, & genitourinary exams Testing: bladder diary, stress test, urinalysis, renal function Optional: PVR, urodynamics, cytology, other lab tests

    4. Slide 25 ASSESSMENT: HISTORY Initiate discussion (50% do not report UI) Ask about specific symptoms: urgency (eg, with running water), frequency, nocturia, slow stream, terminal dribbling Determine UI characteristics: type (with urgency, stress maneuvers, insensate), onset, frequency, volume, timing, precipitants Identify associated factors: bowel & sexual function, medical conditions, medications Ask about quality of life: patients, caregivers

    5. Slide 27 ASSESSMENT: PHYSICAL (2 of 4) Musculoskeletal: mobility, manual dexterity Neurologic: cervical disease suggested by limited lateral rotation & lateral flexion, interossei wasting, Hoffmann's or Babinskis sign; lower extremity motor or sensory deficits Genitourinary: Men: prostate consistency, masses (cannot tell size by DRE); if uncircumcised, check for phimosis, paraphimosis, balanitis Women: vaginal mucosa for atrophy, pelvic support, prolapse Sacral reflexes Anal wink Bulbocavernosus reflex

    6. Slide 38 BLADDER TRAINING FOR COGNITIVELY INTACT PATIENTS Urgency suppression Be still, dont run to the bathroom Do pelvic muscle contractions When urgency decreases, then go to the bathroom Scheduled voiding while awake Initial toileting frequency: About 2 hrs, or use the shortest interval between voids from bladder diary if possible After 2 days without leakage: ? time between scheduled voids by 3060 min, until can go 4 hours without leakage Success may take several weeks; reassure patient about any initial failures

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