Female Urinary Incontinence Flashcards
1
Q
outline the bladder nerve supply
A
P-Peeing –> Parasympathetic
S-Storage–> Sympathetic
V-Voluntary–> Pudendal nerve
2
Q
what happens during bladder filling?
A
- cortical activity causes INCREASED sphincter contraction
- activation of sympathetic and inhibition of parasympathetic
3
Q
what happens during bladder emptying?
A
- detrusor contraction
- sphincter relaxation
- activation of parasympathetic and inhibition of sympathetic
4
Q
what is urinary incontinence?
A
involuntary leakage of urine
5
Q
identify the 3 types of urinary incontinence
A
- 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
6
Q
Risk factors of UI?
A
- mainly pregnancy and childbirth
- increased age
- smoking
- menopause
- increased intra-abdo pressure
- pelvic floor trauma
7
Q
What does diagnosis of UI consist of?
A
- history
- examination
- investigation
8
Q
upon taking a history, what are important symptoms to ask about?
A
- irritation symptoms
- increased frequency, urgency, dysuria, haematuria
- incontinence symptoms
- voiding symptoms
- disrupted flow / unable to void
- if any prolapse symptoms
9
Q
what examinations would you do?
A
- abdominal
- gynae
- neurological
- pelvic floor assessment
10
Q
what investigations would you do?
A
- Urinalysis (exclude infection)
- Post voiding residual volume
- Urodynamics
- this is done only if surgery is being considered
11
Q
what are management options?
A
- lifestyle changes
- medical
- physio
- surgical
12
Q
lifestyle changes?
A
stop smoking, lose weight etc
13
Q
what is the 1 st line management for UI?
A
Physio
- Pelvic Floor Muscle Training (PFMT)
- increase in muscle tone and strength
14
Q
what is the medical management of UI and when do you prescribe it
A
- given if PFMT has failed or if PFMT would be enhanced with drug
- stress incontinence –> DULOXETINE
- urge incontinence –> anticholinergic: Oxybutynin
15
Q
how do anticholinergic medications work?
A
blocking parasympathetic system
