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Reproductive > Female Urinary Incontinence > Flashcards

Female Urinary Incontinence Flashcards

1
Q

What are the 2 components of the Urinary Tract?

Wat is the Vesico-ureteric mechanism?

A

The 2 mutually dependent components of the urinary tract include:

  • Upper Tract (Kidneys and Ureters)
    • ​Low pressure distensible conduit with intrinsic peristalsis
    • Transport urine from nephrons via ureters to bladder.
  • Lower Tract (Bladder and Urethra)
    • ​Bladder fils at rate 0.5 - 5ml/min
    • Low pressure storage of urine.
    • Efficient expulsion of urine at appropriate time & place.

Vesico-ureteric mechansism:

  • protects the nephrons from any damage secondary to retrograde transmission of back pressure or infection from the bladder.
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2
Q

Which nerves are responsible for maintaining urine stoarge?

A

Hypogastric nerve (sympathetic)

T10-L2

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3
Q

What nerves are responsible for voiding of urine?

A

Pelvic Nerve (PS)

S2-4

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4
Q

What nerve is reponsible for the voluntary control of urination?

A

Pudendal nerve (somatic)

S2-4

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5
Q

Ouutline how a filling bladder maintains a low pressure.

How are we aware that the bladder is gradually filling?

A

The bladder is a distenible ag, therefore its stretch can ensure increased volume has a limited/no effect on increasing the pressure.

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6
Q

Outline the link between bladder filling and cortical activity.

A
  • Cortical activity: Activating a reciprocal guarding reflex by Rhabdosphincter contraction; increase sphincter contraction & resistance.
    • Activates Sympathetic pathway &
    • Reciprocal inhibition of the Parasympathetic pathway
    • Mediates contraction of bladder base and proximal urethra.
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7
Q

What are the processes that take place in bladder emptying?

What is cortical influence of this?

A
  • Detrusor contraction
  • Urethral Relaxation
  • Spincter co-ordination
  • Absence of Obstruction or anatomical

Cortical Influence (Pontine Micturition Centre)

–> Activation of PS pathway & inhibtion of sympathetic pathway.

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8
Q

Defintions:

  • Urinary Incontinence
  • Stress Urinary Incontinence
  • Urge Urinary incontinence
  • Mixed Urinary incontinence
A
  • Urinary Incontinece
    • ANY involuntary leakage of Urine.
  • Stress Urinary Incontinence
    • Involuntary leakage on effort or exertion, on sneezing or coughing.
  • Urge incontience
    • Involuntary leakage accompanied by or immediately preceded by urgency.
  • Mixed urinary incontinence
    • Involuntary leakage accompanied by or immediately preceded by urgency & on effort of exertion, or on sneezing or coughing.
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9
Q

How does the prevalence of Incontinence vary with age?

A

Prevelence increases with age.

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10
Q

What is the impact of Urinary Incontinece?

A

Urinary Incontinences impact is primarily in terms of its effect on Quality of Life.

  • Reduce social relationships and activities.
  • Impair emotional and psycological well-being.
  • Impair sexaul relationships
  • Embarrassement and diminished self esteem.

Due to this impact of women’s QoL that medical help is sought - however this is after many years of suffering (average 5 years).

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11
Q

What are the risk factors for Urinary Incontinence?

A
  • Age
  • Parity - childbirth is the main risk factor.
  • Menopause
  • Smoking
  • Medical problems
  • Increased abdo pressure
  • Pelvic floor trauma
  • Denervation
  • CT disease
  • Surgery
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12
Q

In a history with Urinary Incontinece - what subjects need to be approached?

A
  • Age, parity, mode of deliveries, weight of heaviest baby, Smoking, HRT,
  • Medical Conditions:
    • DM
    • anti-HTN medications
    • Glaucoma
    • Heart/Kidney/Liver problems, Cognitive problems, Anti-depressants/ anti-psychotics.
  • Previous PFMT, Surgical treatment of SUI or POP
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13
Q

What “iritation Symptoms” can a patient with Urinary Incontinence present with?

A
  • Urgency
  • Increased daytime frequency
  • Nocturia
  • Dysuria
  • Haematuria
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14
Q

What incontince symptoms can someone with UI present with?

A
  • Stress UI
  • Urgency UI
  • Coital Incontinence
  • Severity - How many pads/days?
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15
Q

What voiding symptoms can a patient present with?

A
  • Straining to void
  • Interrupted flow
  • Recurrent UTI
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16
Q

What are the Prolpase and Bowel Symptoms that patients with UI can present with?

A

Prolapse

  • Vaginal Lump / Dragging sensation in vagina

Bowel Symptoms

  • Anal Incontinece
  • Constipation
  • Faecal Evacuation Dysfunction
  • IBS
17
Q

What doe the 3 day Urinary Diary take into account?

A
  • Fluid intake: Quantity & Quality
  • Urine Out-Put (exclude Nocturnal Polyuria)
  • Daytime Frequency,
  • Nocturia
  • Average voided volume.
18
Q

What examinations need to be carried out on women with bladder/pelvic floor problems?

A
  • General
  • Abdominal
  • Nerological
  • Gynaegological
  • Pelvic Floor Assesment (Oxford Scale)
19
Q

What things are being looked flor on examination of the women with bladder/ pelvic floor problems?

A
  • Prolapse
  • Stress incontinence
  • Uro-genital atrophy changes
  • Pelvic mass (space occupying leasion)
  • Pelvic floor tone, strength, awareness
20
Q

What investigations can be used in UI?

A
  • Urinalysis: Multistix +/- MSSU
  • Post voiding residual volume assessment (usually by bladder scanning) only If symptoms of voiding difficulties.
  • Urodynamics: ONLY indicated if surgical treatment is contemplated.
21
Q

What are the different types of management that can be used in UI?

A
  • Lifestyle changes
  • Medical treatments
  • Physiotherapy
  • Surgery
22
Q

What is the management of Stress Urinary Incontinence?

A

Stress incontinence occurs when intra-abdominal pressure exceeds urethral pressure, resulting in leakage.

Urethral closure pressure is increased by:

  • Pelvic Floor Muscle Training
  • Surgery
  • Pharamcological agents
23
Q

What lifestyle changes can be implemented to manage UI?

A
  • Stop smoking
  • Lose weight
  • Eat more healthily - stops constipation
  • Stop drinking alcohol and caffeine
24
Q

What are the benefits of Pelvic Floor Muscle Training?

A
  1. Reinforce corticol awareness of muscle groups
  2. Hypertrophy of existing muscel fibres
  3. General increase in muscle tone

More effective than vaginal cones, electrical stimulation and no treatment.

25
Q

What is the Pharamocological management of UI?

A

Duloxetine - restricted for treatement of moderate to severe stress incontinence, should be part of an overall management strategy which includes Pelvic Floor Exercises.

26
Q

Who should recieve Duloxetine?

A

Primary Care

  • If PFMT has failed or would be enhanced by prescribing Duloxetine.

Secondary Care

  • Does not wish surgery.
  • Not fit for surgery.
  • After failed surgery.
  • When patients family is not complete.
27
Q

What is the “intergral theory of Female UI”?

A

Both Stress and Urge incontinence arise from the same anatomical defect in the anterior vaginal wall & pubo-urethral ligament (PUL).

Urethral/bladder neck closure dysfunction and USI.

28
Q

How can a Suburethral Hammock help UI?

A

Suburethral Hammock laxity might result in stimulation of bladder neck stretch receptors, provoking a premature micturition reflex and Urgency Incontinence.

29
Q

What is TVT?

A

Mid-urethral Slings
Retro-pubic TVT

  • Tension-free vaginal tape (TVT) - minimally invase procedure to reinforce the structures supporting the urethra.
  • Depends on the hammock theory for continence.
  • 80% cure at 11 years follow up.

As effective as colposuspension for treating USI up to 2 years.

Less operative and postop morbidity.

TVT has replace colposuspension as the first choice procedure in SUI treatment.

30
Q

What is overactive bladder syndrome?

What are the defining symptoms?

A
  • A symptom complex usually, but not always related to urodynamically demonstrable detrusor overactivity.

Symptoms:

  • urgency - without uregency incontinence
  • frequency
  • nocturia
31
Q

Risk facotrs for urge incontinece?

A
  • Advanced age
  • Diabetes
  • Urinary tract infections
  • Smoking
32
Q

What is the managemnt of OAB?

A
  • Treat symptoms
  • No immediate cure
  • Multidisciplinary approach
  • Requires dedicated team

Consrevative:

Life Style Interventions

  • Normalise fluid intake
  • Reduce caffeine, fizzy drinks, chocolate
  • Stop smoking
  • Weight loss

Bladder training programme

  • Timed voiding with gradullay increasing intervals.
33
Q

Pharmacological treatment of OAB?

A

Antimuscarinic

Tri-cyclic antidepressants

Botox

Neuromodulation

Reproductive (34 decks)

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