2: Female Incontinence Flashcards
Define incontinence
Involuntary leakage of urine
What are the 5 types of incontinence
- Functional
- Urge
- Stress
- Mixed
- Continuous
What is functional incontinence
Normal urinary system - however individual cannot make toilet in time
What is stress incontinence
Leakage from incompetence sphincter on increase in intra-abdominal pressure
What is urge incontinence
Sudden desire to urinate following by involuntary leakage of urine
What is continuous incontinence
Continual urinary leakage.
How does prevalence of incontinence change with age
Increases
What are the two causes of stress incontinence
- Increase intra-abdominal pressure
- Weak pelvic floor, urethral hypermobility
What can increase intra-abdominal pressure
- Pregnancy
- Obesity
What can cause pelvic floor weakness and urethral hyper mobility
- Childbirth
- Ageing
- Oestrogen withdrawal
- Previous pelvic surgery
What are the causes of urge incontinence
Higher cortical dysfunction:
- Stroke
- PD
- Dementia
Peripheral Neuropathy:
- Diabetes
Other:
- UTI
- Diuretics
- Atrophic vaginitis
- Urethritis
What is mixed incontinence
Stress and urge incontinence
What causes continuous incontinence
Vesicovaginal fistula
What are causes of functional incontinence
- Dementia
- Immobility
How does urge incontinence
Strong desire to urinate followed by urination
How does stress incontinence present
Leakage small amounts of urine on increase IAP
How does mixed incontinence present
Stress and urge
How does continous incontinence present
Continuous leakage urine at all times
What two muscles help maintain continence
- Internal sphincter
- External sphincter
What type of muscle is internal sphincter
smooth muscle
What type of muscle is external sphincter
skeletal muscle
Describe control of internal sphincter
- Involuntary
Describe control of external sphincter
- Voluntary
What happens when bladder fills
Bladder fills trigger stretch receptors that sign spinal cord (S2,S3) and pontine micturition centre to increase parasympathetic stimulation causing detrusor to contract and internal sphincter to relax. It also decreases motor nerve stimulation to external sphincter.
If wanting to voluntary inhibit urination what happens
Pontine centre inhibitors
what happens in urge incontinence
neurogenic disorders cause autonomous contraction of detrusor and uncontrollable micturition
what happens in stress incontinence
increase intra-abdominal pressure causes pressure inside abdomen to overcome sphincter pressure - leading to incontinence.
what is first line investigation for use incontinence
Urinalysis
what is looked for on urinalysis
- Glycosuria
- Nitrites and haematuria
what examination is performed in urge incontinence
Pelvic exam - to look for prolapse or atrophic vaginitis
what investigation is recommended for patients with urge incontinence following urinalysis and pelvic exam
Bladder diary
how long is a bladder diary kept for
3-days
what does bladder diary look at
- Input
- Output
- Urgency
- Frequency and volume of urination
how is post-residual volume measured
Bladder USS
what is first line for managing urge incontinence
conservative: lifestyle advice
what is second-line for urge incontinence
supervised bladder training (6-weeks)
how long is supervised bladder training carried on for
6-Weeks
what medication is offered for urgent incontinence if supervised mechanism have failed
Oxybutynin (Tolterodine)
when should oxybutynin (tolteridine) not be offered and why
> 75-years due to exacerbating delirium. Use mirabegron instead
how long does tolterodine take to work and hence when should patient be reviewed
4W
what is fourth-line for urge incontinence
botulism injection in bladder
when should incontinence pads only be used in urge incontinence
whilst awaiting treatment
what is first line for investigating stress incontinence
Pelvic exam
why is pelvic exam performed in stress incontinence
- Look for pelvic floor weakness
what is the stress test
Ask patient to cough and small amount of urine will leak out
what is performed prior to surgery in women with stress incontinence
Urodynamic studies
what is first-line for stress incontinence
Conservative: lifestyle advice
what 4 pieces of lifestyle advice may be given
- Smoking cessation
- Reduce caffeine
- Reduce alcohol
- Weight loss
what is second-line management of stress incontinence
supervised pelvic floor training
what is supervised pelvic floor muscle training also known as
Kegel exercises
what are kegel exercises
8 contractions, 3 times a day - for 3-months
if Kegel exercises have failed what is offered
Surgery
what types of surgery may be offered for stress incontinence
Mid-urethral tape
Colposuspension
Rectal-fascial sling
Bulking agents
if a patient is unsuitable for surgery, what is indicated
Duolextine
what is the MOA of duolextine
NA and 5-HT re-uptake inhibitor
what is the pelvic floor made up of
levator ani
Coccygeus
what is the levator ani made up of
- Illiococcygeus
- Puborectalis
- Pubococcygeus
what is overactive bladder syndrome
urgency without urge incontinence
