Female Urinary Incontinence Flashcards
1
Q
What are the 2 parts of the urinary tract?
A
- Upper urinary tract
- Ureters and kidneys
- Low pressure distensible conduit with intrinsic peristalsis
- Transports urine from nephrons via ureters to bladder
- Lower urinary tract
- Bladder and urethra
- Bladder fills at rate of 0.5-5mls/min
- Low pressure storage of urine
2
Q
What is the upper urinary tract composed of?
A
- Ureters and kidneys
3
Q
What is the lower urinary tract composed of?
A
- Bladder and urethra
4
Q
The bladder fills at what rate?
A
- Bladder fills at rate of 0.5-5mls/min
5
Q
What nerves supply the bladder?
A
6
Q
How does the bladder accomodate increasing volume at constantly low pressure?
A
- Accommodates increasing volume at constantly low pressure by inhibition of contractions by giving gradual awareness to filling
- Cortical activity to allow this, activates reciprocal guarding reflex by Rhabdosphincter contraction, increasing sphincter contraction and resistance
- Activates sympathetic pathway and reciprocal inhibition of parasympathetic pathway, mediates contraction at bladder base and proximal urethra
7
Q
How is bladder emptying achieved?
A
- Requires detrusor contraction, urethral relaxation, sphincter co-ordination, absence of obstruction or shunts
- Cortical activity
- Pontine micturition centre
- Activation of parasympathetic pathway and inhibition of sympathetic pathway
8
Q
What is urinary incontinence (UI)?
A
Any involuntary leakage of urine
9
Q
What is stress urinary incontinence (SUI)?
A
- Involuntary leakage on effort or exertion, on sneezing or coughing
10
Q
What is urge urinary incontinence (UUI)?
A
- Involuntary leakage accompanied by or immediately preceded by urgency
11
Q
What is mixed urinary incontinence (MUI)?
A
- Involuntary leakage accompanied by or immediately preceded by urgency and on effort or exertion, or on coughing or sneezing
12
Q
What are the different kinds of urinary incontinence?
A
- Urinary incontinence (UI)
- Any involuntary leakage of urine
- Stress urinary incontinence (SUI)
- Involuntary leakage on effort or exertion, on sneezing or coughing
- Urge urinary incontinence (UUI)
- Involuntary leakage accompanied by or immediately preceded by urgency
- Mixed urinary incontinence (MUI)
- Involuntary leakage accompanied by or immediately preceded by urgency and on effort or exertion, or on coughing or sneezing
13
Q
What is the aetiology of female urinary incontinence?
A
- Anatomical defect in the anterior vaginal wall and pubo-urethral ligament
14
Q
What is the prevalence of female urinary incontinence?
A
- 10-25% of woman age 15-60
- 15-40% of woman over 60
- Prevalence increases with age
15
Q
What are risk factors for female urinary incontinence?
A
- Age
- Parity
- Menopause
- Smoking
- Medical problems
- Increased abdominal pressure
- Pelvic floor trauma
- Denervation
- Connective tissue disease
- Surgery
16
Q
What is the presentation of female urinary incontinence?
A
- Irritation symptoms
- Urgency (sudden compelling desire to void)
- Increased daytime frequency (>7)
- Nocturia (>1)
- Dysuria
- Naematuria
- Incontinence symptoms
- Stress UI
- Urgency UI
- Coital incontinence (during sexual intercourse)
- Voiding symptoms
- Straining to void
- Interrupted flow
- Recurrent UTI
- Prolpase symptoms
- Vaginal lump, dragging sensation in vagina
- Bowel symptoms
- Anal incompetence
- Constipation
- Faecal evacuations
- Dysfunction
- IBS
17
Q
What is the medical term for incontinence during sex?
A
Coital incontinence
18
Q
What investigations should be done for urinary incontinence?
A
- 3 day urinary diary
- Looks at fluid intake (quantity and quality), urine out-put, daytime frequency, nocturia, average voided volume
- Urinalysis
- Post voiding residual volume assessment (usually by bladder scanning)
- Urodynamics
- Only if indicated if surgical treatment is contemplated
19
Q
What does a urinary diary record?
A
- Looks at fluid intake (quantity and quality), urine out-put, daytime frequency, nocturia, average voided volume
20
Q
What is the management of female urinary incontinence?
A
- Stress urinary incontinence occurs when intra-abdominal pressure exceeds urethral pressure, causing leakage. So management is aimed at increasing urethral closure pressure
- Lifestyle changes
- Stop smoking, lose weight, healthy food, stop drinking alcohol and caffeine
- Indications – everyone unless they do not wish it or previously failed
- Physiotherapy
- Pelvic floor muscle training
- Effect – reinforcement of cortical awareness of muscle groups, hypertrophy of existing muscle fibres, general increase in muscle strength and tone
- Pelvic floor muscle training
- Pharmacological
- Duloxetine
- Indication – moderate to severe stress urinary incontinence, does not wish for surgery or previous failed surgery, patients family is not complete
- Duloxetine
- Surgical
- Colposuspension
- Urethral/bladder neck closure
- Suburethral sling
- Tension free vaginal tape (TVT)
- Advantages – less operative and postoperative morbidity than colposuspension
- Complications – bladder perforation, vaginal and urethral erosion, vascular injuries
21
Q
What lifestyle changes can help with female urinary incontinence?
A
- Stop smoking, lose weight, healthy food, stop drinking alcohol and caffeine
22
Q
What is the effect of pelvic floor muscle training?
A
- Effect – reinforcement of cortical awareness of muscle groups, hypertrophy of existing muscle fibres, general increase in muscle strength and tone
23
Q
What drug can be used for female incontinence?
A
- Duloxetine
- Indication – moderate to severe stress urinary incontinence, does not wish for surgery or previous failed surgery, patients family is not complete
24
Q
What surgery can be done for female incontinence?
A
- Colposuspension
- Urethral/bladder neck closure
- Suburethral sling
- Tension free vaginal tape (TVT)
- Advantages – less operative and postoperative morbidity than colposuspension
- Complications – bladder perforation, vaginal and urethral erosion, vascular injuries
25
What are possible complications of female urinary incontinence?
* Reduced quality of life
* Reduce social relationships and activities
* Mental health
* Impair emotional and psychological well-being, sexual relationships, embarrassment
26
What is overactive bladder syndrome?
A symptom complex usually, but not always, related to urodynamically demonstrable detrusor overactivity
27
Describe the epidemiology of overactive bladder syndrome (age, sex)?
* Prevalence increases with age, woman affected more than men until age exceeds 65 then men are affected more than woman
28
What are risk factors for urge incontinence?
* Advanced age
* Diabetes
* Urinary tract infections
* Smoking
29
What are the defining symptoms of overactive bladder syndrome?
* Urgency (with/without urgency incontinence), usually with frequency and nocturia
* Definitions of symptoms
* Urgency – complaint of sudden, compelling desire to pass urine
* Urge incontinence – complaint of involuntary leakage of urine accompanied or immediately preceded by urgency
* Frequency – voids to often
* Nocturia – wake during the night to void
30
What is urgency?
* Urgency – complaint of sudden, compelling desire to pass urine
31
What is urge incontinence?
* Urge incontinence – complaint of involuntary leakage of urine accompanied or immediately preceded by urgency
32
What is frequency?
* Frequency – voids to often
33
What is nocturia?
* Nocturia – wake during the night to void
34
What is the management for overactive bladder syndrome?
* Life style interventions
* Normalise fluid intake, reduce caffeine, fizzy drinks, chocolate, stop smoking, weight loss
* Bladder training programme
* Timed voiding with gradually increasing intervals
* Pharmacological
* Antimuscarinic, could be
* Solifenacin (Vesicare 5-10mg )
* Fesoteridine (Toviaz 4-8 mg)
* Trospium Chloride (60mg XL)
* Darifencain (Emselex 7.5-15 mg ) – Constipation; FI
* Lyrinel XL (10-20 mg )
* Oxybutinin (5-10 mg/ tds)
* Kentera Patches
* Tri-cyclic antidepressants
* Imipramine
* Recent advances on treatment
* Botox
* Neuromodulation
* Needle stimulation
* Effect – reflex inhibition to the detrusor muscle
