1: Urinary Incontinence Flashcards
What is urinary incontinence
Involuntary leakage of urine
What are the 5 types of incontinence in a female
- Stress incontinence
- Urge incontinence
- Mixed incontinence
- Functional incontinence
- Continous incontinence
What is stress incontinence
Due to an incompetent sphincter - which results on the leakage of urine when there is an increase in intra-abdominal pressure
What is urge incontinence
Sudden urge to urinate followed by uncontrollable emptying of the bladder
What is mixed incontinence
A mix of urge and stress incontinence
What is functional incontinence
Physiologically individual is normal, however, cannot make it to the toilet in time due to other co-morbidities
What is continous incontinence
When there is a continous leakage of urine
What is the most common type of incontinence in females
mixed and stress
What are the 3 causes of stress incontinence (3Ps)
pelvic floor weakness
prolapse
pelvic mass
What are may cause urge incontinence
latchkey incontinence organic brain damage UTI diabetes diuretics atrophic vaginitis uretheritis
What is latckey incontinence
sudden urge to urinate when arriving home
What organ brain damage may lead to urge incontinence
PD
Stroke
Dementia
MS
What may cause functional incontinence
Dementia
Delirium
Immobility
What may cause continous incontinence
vesicovaginal fistula
What is the mneomonic to remember reversible causes of incontinence
D I A P E R S
What are reversible causes of incontinence
Delirium Infection Atrophic vaginitis Psychological Excess fluid output Reduced mobility Stool impaction
What are 6 risk factors for stress incontinence
childbirth pregnancy hysterectomy previous pelvic surgery obesity ageing
What are 3 risk factors for urge incontinence
diabetes
UTI
neurological disorder
What is a risk factor for functional incontinence
dementia
how does stress incontinence present
leakage of urine when there is an increase in intra-abdominal pressure (eg. coughing, laughing, sneezing)
How does urge incontinence present
urge to urinate followed by a complete emptying of the bladder
What is the mneumonic to remember storage symptoms
FUN
What are the storage symptoms
Frequency
Urgency
Nocturia
What is the pneumonic to remember voiding symptoms
WIS
- weak stream
- intermittency
- straining
After a history, what examination should be performed to examine incontinence
supine pelvic examination
Following examination what may be performed to investigate incontinence
bladder diary
Why may a urine dip be performed
check for UTI may be causing incontinence. A urine dip should be performed in all women with incontinence
When would a urine culture be taken from someone with urinary incontinence
If someone has symptoms of an UTI
What are 3 other tests may be performed for urinary incontinence
- Flow rate and PR volume
- Pad testing
- Urodynamic studies
What does a reduced flow rate indicate
bladder outlet obstruction or reduced contractibility
What is a normal PVR
<50ml
What is pad testing
incontinence pad is taken and weighed to see how much a person is urinating
In what type of urinary incontinence may urodynamic studies be indicated for
urge incontinence
What is first step in management of stress incontinence
Kegel exercises
What are kegel exercises
8 pelvic contractions, 3 times a day for 3 months
When is a ring pessary used
Evidence of vaginal prolapse
What are two other management options for stress incontinence
Tension-free vaginal tape
Urethral Bulking Agents
What are the two lifestyle measures for urge incontinence
Reduce caffeine
Weight loss
What should patients do before being started in pharmacotherapy for urge incontinence
Complete an incontinence chart for 3 days
What is first-line for urge incontinence
Bladder training - should be performed for a minimum of 6 weeks
What medications may be given for urge incontinence
Anti-muscarinics
Name an anti-muscarinic given for urge incontinence
Tolterodine
When is topical oestrogen given
Vaginal prolapse
When may a B3 adrenergic agonist be given
Anti-muscarinics are contraindicated
What are 2 surgical management options for urge incontinence
- Botox
2. Percutaneous sarcal stimulation
What are the two broad categories of causes for overflow incontinence
Atonic Bladder
Obstruction to flow
What may cause an outlet obstruction to urinary flow in males
BPH
Bladder outlet obstruction
What are 4 causes of atonic bladder
Idiopathic Iatrogenic Trauma Infection Compressed sacral N
What are the storage symptoms of overflow incontinence
Frequency
Urgency
Nocturia
What are the voiding symptoms of overflow incontinence
Weak stream
Intermittency
Straining
How does overflow incontinence present
Continous/intermittent dribbling of urine when the bladder is full without an urge to urinate
How should overflow incontinence be investigated
As BPH
What is used to treat overflow incontinence
Intermittent catheterisation followed by a trial without catheter
+ treat the cause
