Female Urinary Incontinence Flashcards
What nerve is responsible for storage of urine in the bladder?
Hypogastric nerve (T10-12) sympathetic
What nerve is responsible for voiding of urine?
Pelvic nerve (S2-4) parasympathetic
What nerve is responsible for voluntary voiding of urine?
Pudendal nerve (S2-4) somatic
What process occurs when the bladder empties?
Detrusor contraction
Urethral relaxation
What is urinary incontinence?
Any involuntary leakage or urine
What is stress urinary incontinence (SUI)?
Involuntary leakage on effort or exertion, on sneezing or coughing
What is urge urinary incontinence (UUI)?
Involuntary leakage accompanied by or immediately preceded by urgency
What is mixed urinary incontinence (MUI)?
Involuntary leakage accompanied by or immediately preceded by urgency and on effort, exertion, sneezing or coughing
What is the impact of urinary incontinence?
Impair quality of life
Reduce social relationships and activities
Impair emotional and psychological well-being
Impair sexual relationships
Embarrassment and diminished self-esteem
What are the risk factors for urinary incontinence?
Age Parity Menopause Smoking Medical problems Increased intra abdominal pressure Pelvic floor trauma Denervation Connective tissue disease Surgery
What medical conditions are associated with urinary incontinence?
Diabetes Anti-HTN medications Glaucoma Heart/kidney/liver problems Cognitive problems Antidepressants Antipsychotics
What are the irritation symptoms of incontinence?
Urgency Increased daytime frequency Nocturia Dysuria Haematuria
What are the voiding symptoms associated with incontinence?
Straining to void
Interrupted flow
Recurrent UTI
What are the bowel symptoms associated with incontinence?
Anal incontinence
Constipation
IBS
Faecal evacuation
What should be included to fully assess a patient?
3 day urinary diary
Urine dipstick
What investigations should be considered for incontinence?
Urinalysis
Post voidal residual volume assessment
Urodynamics
How does stress incontinence occur?
When intra-abdominal pressure exceeds urethral pressure resulting in leakage
What are the management options for incontinence?
Lifestyle changes
Medical treatments
Physiotherapy
Surgery
What can be done to increase urethral closure pressure?
Pelvic floor muscle training
Surgery
Pharmacological agents
What lifestyle changes can be made to improve incontinence?
Stop smoking
Lose weight
Eat more healthily to avoid constipation
Stop drinking alcohol and caffeine
How does pelvic floor muscle training improve incontinence?
Reinforcement of cortical awareness of muscle groups
Hypertrophy of existing muscle fibres
General increase in muscle tone and strength
What medication can be offered for incontinence?
Duloxetine
What surgical management options are available for incontinence?
Culposuspension
Mid-urethral slings
Retro-pubic tension free vaginal tape (TVT)
What are the symptoms of overactive bladder syndrome?
Urgency
Nocturia
Urge incontinence
Frequency
What are the risk factors for urge incontinence?
Advanced age
Diabetes
UTIs
Smoking
What is the management for overactive bladder syndrome?
Normalise fluid intake Reduce caffeine, fizzy drinks, chocolate Stop smoking Weight loss Bladder retraining
What pharmacological options can be used to treat overactive bladder syndrome?
Antimuscarinic
Tri cyclic antidepressant
Botox
