29/2 Uterine Prolapse Flashcards
What is urinary incontinence
uncontrollable leakage of urine w/ 5 types
Stress incontinence
Urge incontinence
Mixed incontinence
Total incontinence
Other, assoc w/ scoliosis and spinal cord injury
Causes of urinary incontinence
DIAPPERS:
Delirium/Dementia
Infection(reccuring UTI)
Atrophic urethritis/vaginitis
Pharmaceutical(alcohol, caffeine, diuretics)
Psychiatric causes (especially depression)
Excessive urinary output (hyperglycemia, hypercalcemia, CHF
Restricted mobility, spinal injury, scoliosis
Stool impaction.
Causes of stress incontinence
Increased intra-abdominal pressure ( laughing, sneezing, coughing, exercising) → ↑ pressure within the bladder overcomes sphincter resistance
OR
Urinary hypermobility d/2 Poor pelvic support caused by
- pelvic postmenopausal estrogen loss,
- connective tissue disorders,
- childbirth (i.e., damage of the pelvic floor muscle levator ani and/or the S2–S4 nerve roots
Sx of stress incontinence
Leakage of urine upon activities that increase abdominal pressure
Rx of stress incontinence
General principles of treatment of urinary incontinence
Duloxetine: SNRI
surgery
Causes of urge incontinence (involuntary contraction of the detrusor muscle)
Inflammatory conditions (vaginitis) or neurogenic disorders (spinal injury/ dementia)
→ sphincter dysfunction, overactivity of detrusor or overactive bladder
→ autonomous contractions of the detrusor muscle
→ premature initiation of a normal micturition reflex
Leakage of urine
Sx of urge incontinence
Sudden sense of urgency and involuntary leakage
Rx of urge incontinence
General principles
Anticholinergic medication
Surgery
Causes of mixed incontinence
Combination of causes of stress and urge incontinence
Sx of mixed incontinence
Clinical features of both stress and urge
Rx of mixed
General principles
Anticholinergics to Rx the urge aspect
Cause of total incontinence
Total loss of sphincter function d/2
-surgery, metastasis, nerve damage
Abnormal anatomy of sphincter
-fistula bet/w urinary tract and skin
Sx of total incontinence
CONSTANT urinary leakage w/o triggers
Rx of total incontinence
General principles
Usually surgery
Causes of overflow incontinence
Impaired contraction of detrusor muscle
-usually d/2 anticholinergic medications
Bladder outlet obstruction d/2 mech/ functional block such as BPH, urethral stricture and posterior urethral valves
→ chronic distended bladder with ↑ bladder pressure
→ dribbling of urine when intravesical pressure overcomes sphincter outlet resistance
Sx of overflow incontinence
Frequent, involuntary dribbling of urine in the absence of an urge to urinate
Can be continuous or intermittent
Occurs only when the bladder is full
Often occurs with changes in position
Rx of overflow incontinence
Acute settings: intermittent catheterization
Timed voiding for day to day management
Treatment of underlying condition
What are the other causes of urinary incontinence
Commonly seen in multiple sclerosis or spinal cord injury
Detrusor sphincter dyssynergia! =
simultaneous contractions detrusor muscle and activation of the internal urethral sphincter
Causes blockage of bladder outlet
small amounts of urine are pressed through the contracted sphincter muscle
This causes high intravesical pressure along with inappropriate contraction of the urethral sphincter
Sx of detrusor sphincter dyssynergia
Voiding dysfunctions
Intermittent voiding
Urinary retention
Small volume
Reflex incontinence: leakage of urine w/o urge to void
Rx of detrusor sphincter dyssynergia
General principles
Injection of botulinum toxin into detrusor. paralysis prevents involuntary contractions for ∼ 6 months
Transurethral resection of external urinary sphincter (TURS)
Alpha-blockers and/or anticholinergics
Urethral stent placement
Implantation of a bladder pacemaker
Surgical insertion of the pulse generator at the S2–S4 ventral root
Dg tests for urinary incontinence
General dg
Detailed medical history (including medication)
Voiding diary to assess frequency and volume of micturition
Neurological, vaginal, and rectal examination
Laboratory tests
Urine dipsticks and urine culture to exclude urinary tract infections
Creatinine and blood urea nitrogen (BUN)
Imaging
Renal ultrasound
Urodynamic examination to measure bladder pressure and urethral closure pressure
Cystoscopy to rule out tumors and vesicorectal or vesicovaginal fistulae
MRI to identify pelvic floor defects
Rx of urnary incontinence
Remove causes( drugs etc)
Leakage prevention
-catheter, pessaries,
Lifestyle changes
-weight loss, diet etc
Behavioural therapy
-kegel excercise, bladder training,
Medication
-topical vaginal estrogen for postmenopause
-
Complication of urinary incontinence
General: depression, psychosocial distress
prolonged contact with urine: dermatitis, skin infections, and sores
Urinary tract: increased risk of urinary tract infections
