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
