Female Urinary Incontinence Flashcards
What proportion of women experience incontinence post partum?
30-40%
What is stress incontinence?
Leakage associated with some form of stress
What is retention with overflow?
Overfilling and voiding without feeling need
What are the mechanisms of stress incontinence?
Defects in pelvic floor
Urethral sphincter deficiency
What is healthy bladder activity?
Holds 300-500ml
Voids 8x per day
Up to once at night
What medical condition do you screen for in incontinence?
Narrow-angle glaucoma
Which medications interact with incontinence particularly?
Anti-cholinergics
Diuretics
Anti-hypertensives
What do you do on exam?
Mobility, MSE, Manual dexterity, Neurological, BMI Abdominal and bimanual exam Vulval and vaginal skin: atrophy Cough test Pelvic floor muscle strength
How does menopause contribute to incontinence?
Lowered oestrogen exacerbates but does not cause the incontinence so replacement helps
How do you investigate incontinence?
MSU Post-void residual Bladder diary/QoL questionnaires Urodynamics: uroflowmetry, cystometry, urethral pressure profilometry Videourodynamics Cystourethroscopy
Rate modes of delivery by risk of incontinence
Forceps
Vaginal
Caesarean
What is the conservative management of SI?
Pelvic floor exercises Biofeedback Electrical stimulations Pads, tampons Pessary
When are pelvic floor exercises effective?
Stress incontinence due to weakness at bladder neck (not sphincter)
Urge incontinence
What are the operations for SI?
Vaginal Sling procedure
Periurethral bulking agent
What is the conservative mx in UI?
1.5L per day of fluids
Avoid alcohol and caffeine
Pelvic floor exercises
Bladder retraining - distraction during urgency to gradually in the time between voids
