NR 601 final study guide
Genitourinary Disorders
Urinary incontinence. Chapter 23-
o urge(anticholinergics; oxybutynin aka Ditropan, Tolterodine aka Detrol, Solifenacin
aka Vesicare).
o Stress
o Overactive ( anticholinergics; oxybutynin aka Ditropan, Tolterodine aka Detrol,
Solifenacin aka Vesicare).
o mixed
o overflow(alpha -blockers; tamsulosin aka Flomax, alfuzosin aka Uroxatral,
Silodosin aka Rapaflo, and Doxazosin aka Cardura.
o Types
Stress incontinence occurs when physical activity or exertion, such as
coughing, sneezing, laughing, lifting, walking, or running.
Common Predisposing factors
o Weak pelvic floor muscles, which can occur with aging or
childbirth
o Hormonal changes, especially post-menopause ( lower
estrogen levels).
o Obesity( increased intra- abdominal pressure)
o Chronic coughing or sneezing( from smoking or respiratory
conditions)
o Previous pelvic surgery( hysterectomy)
Urge incontinence: characterized by a strong and sudden urge to urinate
that you leak before reaching the toilet. It is often associated with
overactive bladder( OAB), where the bladder contracts uncontrollably.
Common Predisposing Factors
o Age-related changes in the bladder, including decreased
bladder capacity
o Neurological conditions( stroke, Parkinson’s disease,
multiple sclerosis)
o Bladder infections or irritants
o Medications that affect bladder function( diuretics)
o Caffeine or alcohol consumption
Overflow incontinence- occurs when the bladder becomes over- distended
due to the inability to empty completely. This leads to dribbling or
constant leakage of small amounts of urine.
Common Predisposing Factors
o Bladder outlet obstruction( BPH in men)
o Neurological bladder( DM, spinal cord injuries)
o Weak bladder muscle( detrusor underactivity)
o Medications like anticholinergics that reduce bladder
contraction
Functional incontinence- occurs when a person is unable to reach the
bathroom in time due to physical cognitive impairments, such as mobility
issues or dementia.
, Common Predisposing Factors
o Mobility limitation( arthritis, frailty)
o Cognitive impairments( dementia, Alzheimer’s disease)
o Environmental barriers( inability to access the bathroom
easily due to clutter or obstacles)
Mixed incontinence
Any incontinence
o Predisposing factors
Age
Gender- female due to anatomical and hormonal factors, especially post-
menopause
Obesity
Medical conditions( DM, stroke, Parkinson’s cognitive disorders(
dementia, delirium)
Medications: diuretics, anticholinergics, and certain antidepressants can all
affect bladder control
o Medications that contribute to this issue- alcohol, adrenergic agonists/ blockers,
ACE inhibitors, Anticholinergics, Antipsychotics, CCB, Cholinesterase inhibitors,
Estrogen, Gabapentin, loop diuretics, Narcotic analgesics, NSAIDs, Sedative
hypnotics, Thiazolidinediones, tricyclic antidepressants.
o Pharmacologic therapy is not approved for stress incontinence but may be
prescribed for the management of urgency incontinence or overactive bladder and
includes: Antimuscarinic medications: oxybutynin (Ditropan), tolterodine
(Detrol) and Beta- 3 Agonist: mirabegron( Myrbetriq)
o Treatments- address contributing comorbidity/ lifestyle, medications, functional
impairment, and containment. Behavioral treatments, pharmacologic treatments.
Lifestyle for all types- weight loss, reducing caffeine and alcohol
consumption, decreasing fluid intake before bed, and smoking cessation.
Behaviors for urge, stress, and mixed incontinence. Medication for urge,
urge- predom stress incontinence. Devices for stress incontinence.
Minimally invasive for refractory urge and stress incontinence. Surgery
for stress incontinence.
There are no US Food and Drug Administration-approved medications for
stress UI; Duloxetine is effective in reducing stress.
Antimuscarinics- Oxybutynin, Tolterodine IR, Fesoterodine( prodrug of
tolterodine). Darifenacin( causes constipation). Trospiu( must be given on
an empty stomach).
Urgency UI OAB- Mirabegon(ADEs include HTN; use with caution in
patients with HTN. Use caution with metoprolol and digoxin)
1. Stress Incontinence
Treatment Options:
Behavioral Interventions:
, o Pelvic floor exercises (Kegel exercises): Strengthening the pelvic floor muscles
can help prevent the involuntary leakage of urine during physical activity.
o Bladder training: Helps patients learn to hold urine longer and gradually
increase the time between bathroom visits.
Lifestyle Modifications:
o Weight loss, if applicable, to reduce intra-abdominal pressure.
o Caffeine and alcohol reduction to minimize bladder irritation.
Medications:
o Topical estrogen: Can help improve the strength and tone of the urethral and
vaginal tissues, particularly in postmenopausal women.
o Alpha-adrenergic agonists: Drugs like pseudoephedrine can help increase the
tone of the bladder neck and sphincters, thus reducing leakage.
Surgical Interventions:
o Sling procedures (e.g., midurethral sling): Invasive surgeries to support the
urethra and prevent leakage.
o Colposuspension: A surgical procedure to lift and support the bladder neck.
2. Urgency Incontinence
Treatment Options:
Behavioral Interventions:
o Bladder training: Encourages patients to resist the urge to urinate, thus gradually
increasing bladder capacity.
o Scheduled voiding: Encourages patients to urinate at set times during the day,
reducing the urgency and improving control.
Medications:
o Anticholinergics (e.g., oxybutynin, tolterodine): These reduce bladder muscle
overactivity and increase bladder capacity.
o Beta-3 adrenergic agonists (e.g., mirabegron): Relax the bladder muscle and
help with increased bladder capacity.
Lifestyle Modifications:
o Reduce irritants like caffeine and artificial sweeteners.
o Weight management to reduce pressure on the bladder.
Pelvic Floor Exercises: Can help in some cases to strengthen muscles that help control
bladder function.
3. Overflow Incontinence
Treatment Options:
Behavioral Interventions:
o Double voiding: Encouraging patients to urinate, then wait a few minutes and try
again to fully empty the bladder.
Medications:
Genitourinary Disorders
Urinary incontinence. Chapter 23-
o urge(anticholinergics; oxybutynin aka Ditropan, Tolterodine aka Detrol, Solifenacin
aka Vesicare).
o Stress
o Overactive ( anticholinergics; oxybutynin aka Ditropan, Tolterodine aka Detrol,
Solifenacin aka Vesicare).
o mixed
o overflow(alpha -blockers; tamsulosin aka Flomax, alfuzosin aka Uroxatral,
Silodosin aka Rapaflo, and Doxazosin aka Cardura.
o Types
Stress incontinence occurs when physical activity or exertion, such as
coughing, sneezing, laughing, lifting, walking, or running.
Common Predisposing factors
o Weak pelvic floor muscles, which can occur with aging or
childbirth
o Hormonal changes, especially post-menopause ( lower
estrogen levels).
o Obesity( increased intra- abdominal pressure)
o Chronic coughing or sneezing( from smoking or respiratory
conditions)
o Previous pelvic surgery( hysterectomy)
Urge incontinence: characterized by a strong and sudden urge to urinate
that you leak before reaching the toilet. It is often associated with
overactive bladder( OAB), where the bladder contracts uncontrollably.
Common Predisposing Factors
o Age-related changes in the bladder, including decreased
bladder capacity
o Neurological conditions( stroke, Parkinson’s disease,
multiple sclerosis)
o Bladder infections or irritants
o Medications that affect bladder function( diuretics)
o Caffeine or alcohol consumption
Overflow incontinence- occurs when the bladder becomes over- distended
due to the inability to empty completely. This leads to dribbling or
constant leakage of small amounts of urine.
Common Predisposing Factors
o Bladder outlet obstruction( BPH in men)
o Neurological bladder( DM, spinal cord injuries)
o Weak bladder muscle( detrusor underactivity)
o Medications like anticholinergics that reduce bladder
contraction
Functional incontinence- occurs when a person is unable to reach the
bathroom in time due to physical cognitive impairments, such as mobility
issues or dementia.
, Common Predisposing Factors
o Mobility limitation( arthritis, frailty)
o Cognitive impairments( dementia, Alzheimer’s disease)
o Environmental barriers( inability to access the bathroom
easily due to clutter or obstacles)
Mixed incontinence
Any incontinence
o Predisposing factors
Age
Gender- female due to anatomical and hormonal factors, especially post-
menopause
Obesity
Medical conditions( DM, stroke, Parkinson’s cognitive disorders(
dementia, delirium)
Medications: diuretics, anticholinergics, and certain antidepressants can all
affect bladder control
o Medications that contribute to this issue- alcohol, adrenergic agonists/ blockers,
ACE inhibitors, Anticholinergics, Antipsychotics, CCB, Cholinesterase inhibitors,
Estrogen, Gabapentin, loop diuretics, Narcotic analgesics, NSAIDs, Sedative
hypnotics, Thiazolidinediones, tricyclic antidepressants.
o Pharmacologic therapy is not approved for stress incontinence but may be
prescribed for the management of urgency incontinence or overactive bladder and
includes: Antimuscarinic medications: oxybutynin (Ditropan), tolterodine
(Detrol) and Beta- 3 Agonist: mirabegron( Myrbetriq)
o Treatments- address contributing comorbidity/ lifestyle, medications, functional
impairment, and containment. Behavioral treatments, pharmacologic treatments.
Lifestyle for all types- weight loss, reducing caffeine and alcohol
consumption, decreasing fluid intake before bed, and smoking cessation.
Behaviors for urge, stress, and mixed incontinence. Medication for urge,
urge- predom stress incontinence. Devices for stress incontinence.
Minimally invasive for refractory urge and stress incontinence. Surgery
for stress incontinence.
There are no US Food and Drug Administration-approved medications for
stress UI; Duloxetine is effective in reducing stress.
Antimuscarinics- Oxybutynin, Tolterodine IR, Fesoterodine( prodrug of
tolterodine). Darifenacin( causes constipation). Trospiu( must be given on
an empty stomach).
Urgency UI OAB- Mirabegon(ADEs include HTN; use with caution in
patients with HTN. Use caution with metoprolol and digoxin)
1. Stress Incontinence
Treatment Options:
Behavioral Interventions:
, o Pelvic floor exercises (Kegel exercises): Strengthening the pelvic floor muscles
can help prevent the involuntary leakage of urine during physical activity.
o Bladder training: Helps patients learn to hold urine longer and gradually
increase the time between bathroom visits.
Lifestyle Modifications:
o Weight loss, if applicable, to reduce intra-abdominal pressure.
o Caffeine and alcohol reduction to minimize bladder irritation.
Medications:
o Topical estrogen: Can help improve the strength and tone of the urethral and
vaginal tissues, particularly in postmenopausal women.
o Alpha-adrenergic agonists: Drugs like pseudoephedrine can help increase the
tone of the bladder neck and sphincters, thus reducing leakage.
Surgical Interventions:
o Sling procedures (e.g., midurethral sling): Invasive surgeries to support the
urethra and prevent leakage.
o Colposuspension: A surgical procedure to lift and support the bladder neck.
2. Urgency Incontinence
Treatment Options:
Behavioral Interventions:
o Bladder training: Encourages patients to resist the urge to urinate, thus gradually
increasing bladder capacity.
o Scheduled voiding: Encourages patients to urinate at set times during the day,
reducing the urgency and improving control.
Medications:
o Anticholinergics (e.g., oxybutynin, tolterodine): These reduce bladder muscle
overactivity and increase bladder capacity.
o Beta-3 adrenergic agonists (e.g., mirabegron): Relax the bladder muscle and
help with increased bladder capacity.
Lifestyle Modifications:
o Reduce irritants like caffeine and artificial sweeteners.
o Weight management to reduce pressure on the bladder.
Pelvic Floor Exercises: Can help in some cases to strengthen muscles that help control
bladder function.
3. Overflow Incontinence
Treatment Options:
Behavioral Interventions:
o Double voiding: Encouraging patients to urinate, then wait a few minutes and try
again to fully empty the bladder.
Medications:
