Female Urinary Incontinence Flashcards
outline the bladder nerve supply
P-Peeing –> Parasympathetic
S-Storage–> Sympathetic
V-Voluntary–> Pudendal nerve
what happens during bladder filling?
- cortical activity causes INCREASED sphincter contraction
- activation of sympathetic and inhibition of parasympathetic
what happens during bladder emptying?
- detrusor contraction
- sphincter relaxation
- activation of parasympathetic and inhibition of sympathetic
what is urinary incontinence?
involuntary leakage of urine
identify the 3 types of urinary incontinence
- Stress Urinary Incontinence
- involuntary leakage of urine caused by effort / exertion ie coughing, sneezing
- Urge Urinary Incontinence
- involuntary leakage of urine associated with or preceded by urgency
- Mixed Urinary Incontinence
- both
Risk factors of UI?
- mainly pregnancy and childbirth
- increased age
- smoking
- menopause
- increased intra-abdo pressure
- pelvic floor trauma
What does diagnosis of UI consist of?
- history
- examination
- investigation
upon taking a history, what are important symptoms to ask about?
- irritation symptoms
- increased frequency, urgency, dysuria, haematuria
- incontinence symptoms
- voiding symptoms
- disrupted flow / unable to void
- if any prolapse symptoms
what examinations would you do?
- abdominal
- gynae
- neurological
- pelvic floor assessment
what investigations would you do?
- Urinalysis (exclude infection)
- Post voiding residual volume
- Urodynamics
- this is done only if surgery is being considered
what are management options?
- lifestyle changes
- medical
- physio
- surgical
lifestyle changes?
stop smoking, lose weight etc
what is the 1 st line management for UI?
Physio
- Pelvic Floor Muscle Training (PFMT)
- increase in muscle tone and strength
what is the medical management of UI and when do you prescribe it
- given if PFMT has failed or if PFMT would be enhanced with drug
- stress incontinence –> DULOXETINE
- urge incontinence –> anticholinergic: Oxybutynin
how do anticholinergic medications work?
blocking parasympathetic system
what is the surgical management of UI?
Tension-Free Vaginal Tape
describe the pressure- transmission theory of incontinence
increased intra-abdominal pressure puts pressure on bladder and on proximal urethra keeping it closed
describe the 2 integral theories of UI
- both urge and stress UI are due to the same anatomical defect in anterior vaginal wall and pubourethral ligament
- causes failure of closure of bladder neck / urethra
- suburethral hammock laxity
- stimulation of bladder neck stretch receptors –> UI
what is Overactive Bladder Syndrome caused by?
overactive detrusor
symptoms of overactive bladder syndrome
increased frequency and urgency
RF of overactive bladder syndrome
- smoking
- diabetes
- increased age
treatment of overactive bladder syndrome?
- lifestyle interventions
- Bladder Training programme
- Tricyclic antidepressants
- anti-muscarinic
