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Effective Management of Urinary Incontinence: Understanding Types, Causes, and Treatments

Incontinence can significantly impact patients' lives, manifesting in various forms such as overflow retention and stress-related issues. This comprehensive guide reviews the types of incontinence, including their causes like neurological conditions and medication side effects. It outlines essential assessments like post-void residual checks and digital rectal exams, as well as treatment options ranging from timed voiding and medications to surgical interventions. Learn how to manage urgency, frequency, and associated complications effectively to improve your patients' quality of life.

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Effective Management of Urinary Incontinence: Understanding Types, Causes, and Treatments

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Presentation Transcript

  1. When Your Patients Gotta Go!!!!! Raji Gill, D.O., M.Sc. Clinical Assistant Professor of Surgery Division of Urology Oklahoma State University

  2. Incontinence • Types • Overflow / retention • Stress / overactive

  3. History • Urgency, frequency, nocturia • Incomplete bladder emptying • Leak when straining • Weak stream, post void dribbling

  4. Past Medical Conditions • Multiple sclerosis, spinal cord injury • Diabetes • Parkinsons Disease

  5. Medications • Worsen overflow • Ephedrine (Rynatuss), pseudoephidrine, imiprimine (Tofranil) Worsen stress • Clonidine (Catapress), phenoxybenzamine

  6. Physical • Check post void residual (PVR) • Normal less than 50cc • Abnormal more than 200cc • Digital rectal exam • Larger prostate (more than • 40 gms)

  7. Treatment • Overflow / retention • If PVR 50 – 200cc, timed voids, double voids • If PVR > 200cc, straight cath or foley • Stress / overactive • Do not hold urine

  8. Medical Therapy • Overflow • Alpha blockers act on smooth muscle receptors in the prostate (Hytrin, Cardura, Flomax) • 5 alpha reductase inhibitor lowers dihydrotestosterone levels (Proscar, Avodart) • Stress / overactive • Anticholinergics for involuntary detrusor contraction (Ditropan, Detrol) • Tricyclic anidepressants (Imipramine, Tofranil)

  9. Surgical Therapy • TURP, microwave therapy, thermotherapy for enlarged prostates • Periurethral injections • Urethral suspensions • Sphincter prosthesis • Sacral nerve stimulation

  10. The End

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