10: Urinary incontinence Flashcards
What is incontinence?
Involuntary leakage of urine
Incontinence is very ___ for the patient.
embarrassing
Incontinence is more common in (men / women).
women
Why is incontinence more common in women?
They only have one urethral sphincter so rely on pelvic floor
Men have two
In micturition, the internal urethral orifice ___ and the bladder ___.
relaxes
contracts
During filling, the bladder muscle ___.
During voiding, the bladder muscle ___.
relaxes
contracts
What two structures fail to cause incontinence?
Either a
sphincter problem
overactive bladder muscle problem
Which receptors detect the filling of the bladder?
Stretch receptors
Which spinal nerves control the micturition reflex?
S2,3,4
What neuro mechanisms control
a) involuntary voiding
b) voluntary inhibition of voiding?
a) Micturition reflex (parasympathetics of S2,3,4)
b) Pons
What urinary problems occur in
a) CNS problems e.g Parkinson’s
b) severed spinal cord?
c) problems with the sacral spinal nerves?
a) Micturition reflex persists, so incontinence
b) Detrusor sphincter dyssnergia
c) Retention
What is urge incontinence?
Incontinence preceded by URGENCY
i.e desire to void
What is stress incontinence?
Involuntary voiding due to raised IAP e.g in coughing, laughing
What is overflow incontinence?
Involuntary urination associated with obstruction
What are types of incontinence causing
a) bedwetting
b) terminal dribble?
a) Nocturnal enuresis
b) Post-micturition dribble
Which neuro disorders increase your chances of incontinence?
Parkinson’s
MS
Stroke
What are some anatomical causes of incontinence?
Ectopic ureters
Fistulas
Traumatic childbirth
Why does smoking cause incontinence?
Cough
Why can obesity cause incontinence?
Weakened pelvic floor muscles
Which drugs can cause urinary incontinence?
Alpha blockers
cause ureteric relaxation
What are some important questions to ask in the history of someone with incontinence?
How often?
Volume?
When (day / night)?
ICE
What examinations are done for someone with incontinence?
Abdominal exam
PR exam
PV exam
What should be checked on PR exam of someone with urine obstruction?
Prostate gland
Anal tone
Which investigation measures urine flow?
Uroflowmetry
What does a slow urine flow rate indicate?
Obstruction
Weak detrusor muscle
Why do women have a faster flow rate than men?
Shorter urethra
Less resistance
Higher pressure
What can a patient keep to track their urinary symptoms?
Diary
What investigation allows you to view the anatomy of the bladder?
Cystoscopy
for stricture, stone, tumour, fistula
What scan would be used to check the kidneys in the case of hydronephrosis secondary to obstruction?
USS kidneys
Anything which increases ____ pressure can cause stress incontinence.
intra-abdominal pressure
What causes stress incontinence?
Weak pelvic floor muscles
Weak sphincters
How is stress incontinence managed?
Lifestyle - avoid caffeine, stop smoking, optimise respiratory treatments, lose weight
Pelvic floor exercises
Duloxetine - rarely used drug which causes smooth muscle contraction
Surgery - narrowing of bladder neck
Which symptom is associated with urge incontinence?
What causes it?
Urgency
Overactive bladder
Apart from urgency, what symptoms are seen in urge incontinence?
Increased frequency
Nocturia
Urge incontinence is associated with a ___ bladder.
overactive
What should always be asked about when taking a fluid history from patients?
Water
Coffee/Tea
Alcohol
How is urge incontinence managed?
Lifestyle management - fluid restriction, coffee, alcohol
Bladder training
Oxybutynin or tolterodine - anticholinergic, relaxes bladder smooth muscles
Surgery
What type of incontinence is associated with obstruction?
Overflow incontinence
What is the presenting symptom of chronic retention?
Painless abdominal mass
Reduced frequency
Nocturia
Potentially haematuria due to AKI
How is overflow incontinence managed?
ADMIT:
Catheterise
Check renal function
Surgery
What is an anatomical problem of the vagina which causes incontinence?
Vesicovaginal fistula
