11. Female Urinary Incontinence Flashcards
What nerves supply the Bladder?
- T10-L2 - Hypogastric Nerve (Sympathetic) - Storage
- S2-4 - (Parasympathetic)
- S2-4 - Pudendal Nerve (Somatic) - Voiding
Note - Sympathetic = Storage / Parasymapthetic = Power
What is the definition of Urinary Incontinence?
Any involuntary Leakage of Urine
What is the definition of Stress Urinary Incontinence?
Involuntary Leakage on Effort or Exertion (Sneezing / Coughing)
What is the definition of Urge Urinary Incontinence?
Involuntary Leakage accompanied by (or immediately preceded by) Urgency
What is the definition of Mixed Urinary Incontinence?
Involuntary Leakage accompanied by (or immediately preceded by) Urgency AND on Effort or Exertion (Sneezing / Coughing)
What percentage of Women report Urinary Incontinence?
- 10-25% between 15-60
- 15-40% > 60
- > 50% in nursing homes
Note - Prevalence increases with Age
What are the Risk Factors for Urinary Incontinence?
- Age/ Menopause
- Parity - Main Risk For Stress Incontinence
- Smoking / Medical Problems
- Increase in Intra-Abdominal Pressure
- Pelvic Floor Trauma
- Connective Tissue Disease
- Denervation / Surgery
What factors are Covered in a Urinary Incontinence History?
- Risk Factors
- Irritation / Incontinence Symptoms
- Voiding Symptoms
- Effect on QoL
What factors are Covered in a Urinary Incontinence Examination?
- General
- Abdominal - Mass (Space Occupying Lesion)
- Gynaecological - Uro-Genital Atrophy
- Pelvic Floor Assessment - Prolapse
- Neurological
What factors are Covered in a Urinary Incontinence Investigation?
- 3 Days Urinary Diary
- Urinalysis - Multistix +/- MSSU
- Post-Voiding Residual Volume Assessment
- Urodynamics - Uroflowmetry
How is Stress Urinary Incontinence Managed?
- Lifestyle Changes
- Medical Treatments
- Physiotherapy
- Surgery
When does Stress Urinary Incontinence occur?
When Intra-Abdominal Pressure Exceeds Urethral Pressure, resulting in Leakage
In relation to Stress Urinary Incontinence, how is Urethral Closure Pressure Increased?
- Pelvic Floor Muscle Training
- Surgery
- Pharmacodynamic Agents
What Lifestyle Changes helps in the Management of Stress Urinary Incontinence?
- Stopping Smoking
- Losing Weight
- Eat more Healthily to Avoid Constipation
- Stop Drinking Alcohol and Cafeine
How does Pelvic Floor Muscle Training (Physiotherapy) help in Stress Urinary Incontinence?
- Reinforced of Cortical Awareness of Muscle Groups
- Hypertrophy of Existing Muscle Fibres
- General Increase in Muscle Tone / Strength
Note - This is more effective than Electrical Stimulation and Vaginal Cones
What is the Pharmacological Treatment of Stress Urinary Incontinence?
Duloxetine - If PFMT does not work / surgery unfeasible
Where do both Stress and Urge Urinary Incontinence arise from?
The Same Anatomical Defect in the Anterior Vaginal Wall and Pubo-Urethral Ligament
What is the Surgical Management of Stress Urinary Incontinence?
- Retro-Pubic Tension-Free Vaginal Tape (TVT) - reinforce structures supporting the Urethra
- Colposuspension - Bladder gets Elevated to reduce pressure
What are the Safety Concerns with Retro-Pubic Tension-Free Vaginal Tape (TVT)?
- Bladder Perforation
- Vaginal / Urethral Erosions
- Vascular Injury
What is the Definition of Overactive Bladder Syndrome?
A Symptom Complex usually, but not Always, Related to Urodynamically Demonstrable Detrusor Overactivity / Urethrovesicle Dysfunction
What are the Defining Symptoms of Overactive Bladder Syndrome?
- Urgency +/- Urge Urinary Incontinence
2. Frequent Nocturia
What is the Definition of Urgency?
The complaint of a Sudden, Compelling Desire to pass Urine, that is difficult to Defer
What is the Definition of Urge Incontinence?
The complain of Involuntary Leakage of Urine, accompanied by (or immediately preceded by) Urgency
What is the Definition of Frequency?
The compliant by the patient who considers that he/she voids too often by day.
Note - Usually accompanies Urgency (+/- Urge Incontinence)
