Treatment of Urinary Incontinence ACTUAL
QUESTIONS AND CORRECT ANSWERS
epidemiology of UI - Correct answers✔✔UI = involuntary loss of urine
1. 11 of 13mil US patients are women: biggest risk factor is age, >2x as many women affected,
50-70% don't seek treatment, under-reported by about 50%, a leading cause of admission to
nursing homes
2. report by age: 7% in women 20-39yrs, 17% in women 40-59yrs, 23% in women 60-79yrs,
32% in women >80yrs
biggest risk factor for UI - Correct answers✔✔age - has a lot to do with muscle and ability to
control sphincter
categories of incontinence - Correct answers✔✔1. stress incontinence (SUI) = involuntary loss
of urine associated with sneezing, coughing, laughing, lifting, or exercising
2. urge incontinence (UUI) = involuntary leakage accompanied by or immediately preceded by
urgency (overactive bladder)
3. mixed incontinence = both stress and urge factors
4. overflow incontinence = uncommon; overfilled, hypotonic bladder
5. functional incontinence = occurs when patient cannot get to the toilet in a timely fashion
relative prevalence of stress, urge, and mixed UI symptoms in women - Correct
answers✔✔stress (49%) > mixed (29%) > urge (22%)
pathophysiology of SUI - Correct answers✔✔coordinated neuromuscular response called the
"guarding reflex" maintains urinary continence
1. increase in nerve activity → contraction of the urethral sphincter → decrease loss of urine
2. NE and 5-HT play a role in this process
, 3. pelvic floor muscles contract → support bladder → maintain continence
4. SUI may result from insufficient urethral closure and/or intrinsic sphincter deficiency
symptoms of SUI - Correct answers✔✔1. leak urine during physical activity (coughing,
sneezing, laughing, lifting)
2. anxiety about wetting accidents
3. feeling of urgency or frequency is rare
4. lack of nocturia
5. patient can reach bathroom in time when needed
pathophysiology of UUI - Correct answers✔✔1. detrusor muscle in bladder wall normally
remains relaxed until bladder is full; nerve signals tell patient it is time to urinate
2. nerve innervation to the detrusor muscle is cholinergic (primarily M3 receptors)
3. in UUI, involuntary bladder contractions occur as the bladder fills
[patient feels urge but muscle contracting so can't go in time]
symptoms of UUI - Correct answers✔✔1. frequent urination (8+ times over a 24hr period)
2. nocturia (2 or more times a night)
3. feel overwhelming and uncontrollable urge to urinate (urge incontinence)
4. little warning time between feeling the bladder is full and needing to urinate
5. leak urine due to inability to make it to the bathroom in time
6. anxiety about wetting accidents
causes of urinary incontinence - Correct answers✔✔1. aging
2. pregnancy, childbirth, and menopause
QUESTIONS AND CORRECT ANSWERS
epidemiology of UI - Correct answers✔✔UI = involuntary loss of urine
1. 11 of 13mil US patients are women: biggest risk factor is age, >2x as many women affected,
50-70% don't seek treatment, under-reported by about 50%, a leading cause of admission to
nursing homes
2. report by age: 7% in women 20-39yrs, 17% in women 40-59yrs, 23% in women 60-79yrs,
32% in women >80yrs
biggest risk factor for UI - Correct answers✔✔age - has a lot to do with muscle and ability to
control sphincter
categories of incontinence - Correct answers✔✔1. stress incontinence (SUI) = involuntary loss
of urine associated with sneezing, coughing, laughing, lifting, or exercising
2. urge incontinence (UUI) = involuntary leakage accompanied by or immediately preceded by
urgency (overactive bladder)
3. mixed incontinence = both stress and urge factors
4. overflow incontinence = uncommon; overfilled, hypotonic bladder
5. functional incontinence = occurs when patient cannot get to the toilet in a timely fashion
relative prevalence of stress, urge, and mixed UI symptoms in women - Correct
answers✔✔stress (49%) > mixed (29%) > urge (22%)
pathophysiology of SUI - Correct answers✔✔coordinated neuromuscular response called the
"guarding reflex" maintains urinary continence
1. increase in nerve activity → contraction of the urethral sphincter → decrease loss of urine
2. NE and 5-HT play a role in this process
, 3. pelvic floor muscles contract → support bladder → maintain continence
4. SUI may result from insufficient urethral closure and/or intrinsic sphincter deficiency
symptoms of SUI - Correct answers✔✔1. leak urine during physical activity (coughing,
sneezing, laughing, lifting)
2. anxiety about wetting accidents
3. feeling of urgency or frequency is rare
4. lack of nocturia
5. patient can reach bathroom in time when needed
pathophysiology of UUI - Correct answers✔✔1. detrusor muscle in bladder wall normally
remains relaxed until bladder is full; nerve signals tell patient it is time to urinate
2. nerve innervation to the detrusor muscle is cholinergic (primarily M3 receptors)
3. in UUI, involuntary bladder contractions occur as the bladder fills
[patient feels urge but muscle contracting so can't go in time]
symptoms of UUI - Correct answers✔✔1. frequent urination (8+ times over a 24hr period)
2. nocturia (2 or more times a night)
3. feel overwhelming and uncontrollable urge to urinate (urge incontinence)
4. little warning time between feeling the bladder is full and needing to urinate
5. leak urine due to inability to make it to the bathroom in time
6. anxiety about wetting accidents
causes of urinary incontinence - Correct answers✔✔1. aging
2. pregnancy, childbirth, and menopause
