Female Urinary Incontinence Flashcards
4 types of urinary incontinence + their definitions
- Urinary incontinence(UI), Any involuntary leakage of urine
- Stress urinary incontinence (SUI), Involuntary leakage on effort/exertion, sneezing/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 & on effort/exertion or sneezing/coughing
6 risk factors for UI
- Age
- Parity
- Menopause
- Smoking
- Pelvic floor trauma
- Denervation
Pregnancy + childbirth is main risk factor for UI
Hx for UI
- Age, parity, mode of deliveries + heaviest baby, smoking
- DM, glaucoma, heart/liver/kidney problems, anti depressants/psychotics
- Pelvic floor muscle trauma, surgery for pelvic floor prolapse + SUI
- Coital UI
- Severity (how many pads/day)
- Fluid intake (quantity & content)
5 irritation symptoms
- Urgency
- Increased daytime frequency (>7)
- Nocturia (>1)
- Dysuria
- Haematuria
5 components of 3 day urinary diary
- Fluid intake (quantity + content)
- Urine output (exclude nocturnal polyuria)
- Daytime frequency
- Nocturia
- Average voided volume
5 types of exams for UI
- General
- Abdo
- Neuro
- Gynae
- Pelvic floor assessment (oxford scale)
4 specific things to look out for during an exam for UI
- Prolapse
- Uro-genital atrophy changes
- Pelvic mass (space occupying lesion)
- Pelvic floor tone, strength, awareness
3 investigations for UI
- Urinalysis, Multistix +/- MSSU
- Post voiding residual volume assessment, Only if symptoms of voiding difficulties
- Urodynamic, ONLY if surgical treatment is contemplated
4 methods of management for UI
- Lifestyle changes
- Medical treatments
- Physiotherapy
- Surgery
Describe the mechanism of SUI and treatment for it
-SUI occurs when intra-abdo pressure exceeds urethral pressure, resulting in leakage
-Urethral closure pressure is increased by;
Pelvic floor muscle training
Surgery
Pharmacological agents
4 lifestyle changes for UI treatment
- Smoking cessation
- Weight loss
- Healthier diet
- Stop drinking alcohol and caffeine
3 components pelvic floor muscle training (PFMT)
- Reinforcement of cortical awareness of muscle groups
- Hypertrophy of existing muscle fibres
- General increase in muscle tone and strength
Pharmacological treatment for SUI (moderate to severe) and who should receive it
- Duloxetine (should still include PFMT)
- If PFMT has failed or would be enhanced with Duloxetine
- After failed surgery or those unfit for or not interested in surgery
3 surgical treatments for SUI
- Colposuspension
- Mid-urethral sling
- Retro-pubic TVT (Tension-free Vaginal Tape)
TVT has now replaced Colposuspension as 1st choice surgical treatment of SUI
8 year 80% cure rate
3 common surgical complications of TVT
- Bladder perforation (1-21%)
- Vaginal & urethral erosions
Define overactive bladder syndrome (OAB)
-A symptom complex usually related to urodynamically demonstrable detrusor overactivity (DO)
Defining symptoms of OAB
- Urgency (with/without urgency incontinence)
- Usually with frequency + nocturia
Define urgency
A sudden, compelling desire to pass urine that is difficult to defer
Define urge incontinence
Involuntary leakage or urine accompanied by or immediately preceded by urgency
Define frequency
Patient considers they void too often by day
4 risk factors for urge incontinence
- Advanced age
- Diabetes
- UTI
- Smoking
Management of OAB
- Treat symptoms
- No immediate care
- Multidisciplinary approach
- Bladder training programme: Timed voiding with gradually increasing intervals (?continence nurse?)
4 lifestyle changes to treat OAB
- Normalise fluid intake
- Reduce caffeine
- Smoking cessation
- Weight loss
Pharmacological treatment of OAB
Antimuscarinic Drugs (type of anticholinergic drug)
- Oral, Solifenacin
- Transdermal, Kentera patches (active ingredient oxybutynin hydrochloride)
-Tri-cyclic antidepressants, Imipramine (oral)
2 recent treatments for OAB
- Botox
- Neuromodulation (Needle stimulation s2-4, reflex inhibition of detrusor muscle, cheap and minimally invasive)
