female urinary incontinence Flashcards
what are the 2 parts of the urinary tract?
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
what is the vesico-ureteric mechanism?
protects the nephrons from any damage secondary to retrograde transmission of back pressure or infection from the bladder
what nerves supply the bladder?
how does the bladder fill?
accommodates increasing volume at constantly low pressure
inhibition of contractions (sympathetic) -> awareness to filling
cortical activity: increase sphincter contraction & resistance
- activates sympathetic pathway
- reciprocal inhibition of parasympathetic pathway
- mediates contraction at bladder base and proximal urethra
how is the bladder emptied
- 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
what are the different kinds of urinary incontinence?
urinary incontinence (UI): involuntary leakage of urine
stress urinary incontinence (SUI): involuntary leakage on effort/exertion
urge urinary incontinence (UUI): involuntary leakage immediately preceded by urgency
mixed urinary incontinence (MUI): involuntary leakage immediately preceded by urgency and on effort or exertion
what is the prevalence of female urinary incontinence?
10-25% of woman age 15-60
15-40% of woman over 60
prevalence increases with age
what are risk factors for female urinary incontinence?
age
history: parity, menopause
habits: smoking
health: increased abdominal pressure, pelvic floor trauma, denervation, connective tissue disease, surgery
What is the presentation of female urinary incontinence?
irritation symptoms
- urgency (sudden compelling desire to void)
- increased daytime frequency (>7)
- nocturia (>1)
- dysuria
- haematuria
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
what patient examination should be done for urinary incontinence?
3 days urinary diary
- fluid intake (quantity and quality)
- urine out-put
- daytime frequency
- nocturia
- average voided volume
urine dipstick
examination
- prolapse
- stress incontinence
- uro-genital atrophy changes
- pelvic mass
- pelvic floor tone
what investigation should be done for urinary incontinence
urinalysis: multistix + mssu
post voiding residual volume assessment (usually by bladder scanning)
urodynamics
what is the management of female urinary incontinence?
lifestyle: stop smoking, alcohol and caffeine, lose weight, healthy food,
physiotherapy: pelvic floor muscle training
pharmacological: duloxetine
surgical:
- synthetic mid urethral slings (MUS) or retro pubic TVT (mesh)
- autologous (rectal) fascia slings
- colposuspension
- urethral bulking
what is overactive bladder syndrome?
a symptom complex usually, but not always, related to urodynamically demonstrable detrusor overactivity
prevalence increases with age, woman affected more than men until age exceeds 65 then men are affected more than woman
what are the defining symptoms of overactive bladder syndrome?
(exam question)
urgency: complaint of sudden, compelling desire to pass urine that is difficult to defer
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
what are risk factors for urge incontinence?
- advanced age
- diabetes
- urinary tract infections
- smoking
