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Reproduction > Female Urinary Incontinence > Flashcards

Female Urinary Incontinence Flashcards

1
Q

What is the upper urinary tract?

A

Kidneys & ureters

Low pressure distensible conduit with intrinsic peristalsis

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2
Q

What is the lower urinary tract?

A

Bladder & urethra

Low pressure storage of urine

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3
Q

How quickly does the bladder fill with urine?

A

0.5-5mls/min

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4
Q

What is the nerve supply to the bladder?

A

Hypogastric nerve (sympathetic) T10-L2 - STORAGE

Pelvic nerve (parasympathetic) S2-4 - VOIDING

Pudendal nerve (somatic, voluntary) - S2-S4

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5
Q

What cortical activity occurs during bladder filling?

A

Activation of reciprocal guarding reflex by rhabdosphincter (sphincter consisting of striated muscle) contraction, increased sphincter contraction & resistance

Sympathetic activation, reciprocal parasympathetic inactivation –> mediates contraction of bladder base & proximal urethra

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6
Q

What occurs in bladder emptying?

A

Detrusor contraction
Urethral relaxation
Sphincter co-ordination
Absence of obstruction or anatomical shunt
Cortical influence (pontine micturition centre) –> activation of parasympathetic pathway and inhibition of sympathetic pathway

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7
Q

Define urinary incontinence

A

Any involuntary leakage of urine

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8
Q

Define stress urinary incontinence

A

Any involuntary leakage of urine on effort/exertion/sneezing/coughing

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9
Q

Define urge urinary incontinence

A

Involuntary leakage accompanied by or immediately proceeded by urgency

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10
Q

Define mixed urinary incontinence

A

Involuntary leakage accompanied by or immediately preceded by urgency & on effort/exertion/sneezing/coughing

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11
Q

Prevalence of IU increases with what?

A

Age

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12
Q

UI is not lifethreatening so why do we Rx it?

A

QoL issue
Impairs relationships, activity, emotion and mental well being
May lead to embarrassment and low self-esteem

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13
Q

What are the risk factors for UI?

A 
Age
Parity
Menopause
Smoking
Medical problems
Increased intra-abdominal pressure (heavy physical labour) 
Pelvic floor trauma (e.g. childbirth) 
Denervation 
Connective tissue dx
Surgery
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14
Q

What are the main RFs for stress incontinence?

A

Pregnancy & childbirth

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15
Q

What do you want to ask in your hx of UI?

A 
Age, parity, mode of delivery, wt of heaviest baby, smoking, HRT
Medical conditions
Prev pelvic muscle floor trauma/training, surgical Rx of SUI or POP
Irritation symptoms
Incontinence symptoms
Voiding symptoms
Fluid intake 
Effect on QoL out of ten 
Prolapse symptoms 
Bowel symptoms
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16
Q

What do you want to ask about irritation symptoms?

A 
Urgency - sudden, compelling desire to void that is difficult to feder
Increased daytime frequency (>7x)
Nocturia (>1x)
Dysuria
Haematuria
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17
Q

What do you want to ask about voiding symptoms?

A

Straining to void
Interrupted flow
Recurrent UTI

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18
Q

What do you want to ask about fluid intake?

A

Quality & quantity

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19
Q

What do you want to ask about prolapse symptoms?

A

Vaginal lumps

Dragging sensation in vagina

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20
Q

What bowel symptoms do you want to ask about?

A

Anal incontinence
Constipation
Faecal evacuation dysfunction
IBS

21
Q

What should be your initial assessment of a patient with UI?

A

3 day urinary diary
Fluid intake, urine output, daytime freq, nocturia, avg. voided volume, caffeine intake, accidents and what she was doing at the time

22
Q

How do you examine a woman with bladder/pelvic floor problems?

A

Ht, wt
Abdominal - bladder distension
Neurological - esp sacral segment, assess lower limb movement, cognitive dx (esp in elderly), mobility

Gynae - prolapse, urogenital atrophy, pelvic mass, pelvic floor tone, strength, awareness

Pelvic floor assessment - Oxford scale

23
Q

What is the Oxford grading scale for pelvic floor muscles?

A 
0 - no muscle activity
1 - minor muscle flicker
2 - weak muscle activity wo circular contraction 
3 - moderate muscle contraction 
4 - good muscle contraction 
5 - strong muscle contraction
24
Q

What Ix can you do for UI?

A

Urinalysis - multistix +/- MSSU
Post-voiding residual volume assessment (usually bladder scanning) - only if symptoms of voiding difficulties
Urodynamics - only if surgery contemplated

25
Q

How do you manage UI?

A

Lifestyle changes
Medical Rx
Physiotherapy
Surgery

26
Q

When does stress UI occur?

A

When intra-abdominal pressure exceeds urethral pressure (damage to sphincter, weak pelvic floor muscles, sphincter) –> leakage

Can increase urethral closure pressure by PFMT, surgery & drugs

27
Q

What lifestyle changes should be advised for UI?

A

Stop smoking
Lose weight
Eat more healthily to avoid constipation
Stop drinking alcohol & coffee

28
Q

What does PFMT do?

A

Reinforces cortical awareness of muscle groups
Hypertrophy of existing muscles
General increase in muscle tone & strength

29
Q

How many times should you do PFMT?

A

3 sets 5x day

30
Q

What meds can you use for SUI?

A

Duloxetine

Only if mod-severe, PFMT has failed/would be enhanced in primary care, or surgery not wished for in secondary care

31
Q

What is colposuspension?

A

Suturing of bladder neck above pelvic floor (holding it in a lifted position)

Prevents involuntary leaks in those with SUI

32
Q

What is the integral theory of female UI?

A

Both SUI and UUI arise from the same anatomical defect in the anterior vaginal wall and pubo-urethral ligament –> bladder/urethral neck closure dysfunction –> UI

33
Q

What is the hammock theory of female UI?

A

Pubocervical fascia provides hammock like support for visceral neck and therefore is a backboard for compression of the proximal urethra during increased intra-abdominal pressure
Loss of this support would lead to equal transmission of iap

34
Q

What is retropubic TVT?

A

Tension free vaginal tape
Minimally invasive procedure that reinforces the structures supporting the urethra
Used for Rx of SUI

35
Q

What kind of tape is used for TVT?

A

Polypropene permanent synthetic tape

Monofilament macroporous

36
Q

Which of TVT and colposuspension is most effective?

A

Same effectiveness for SUI

TVT 1st line as less operative/post-operative morbidity

37
Q

What are common surgical complications with TVT?

A

Bladder perforation, vaginal and urethral erosions, vascular injuries

38
Q

What is overactive bladder syndrome?

A

Due to detrusor over activity
Urgency +/- frequency/nocturia

Usually caused by involuntary detrusor contraction during filling that are either spontaneous/provoked

39
Q

What is neurogenic overactive bladder syndrome?

A

Abnormal detrusor contractions that are related to a neurologic condition

40
Q

Who is OAB most common in?

A

Older woman

41
Q

Define urinary frequency

A

Complaint of voiding too often by day

42
Q

Define nocturia

A

Complaint that they wake up at night once or more time to void

43
Q

What are risk factors for urge incontinence?

A

Advanced age
DM
Urinary tract infections
Smoking

44
Q

How do you Rx OAB?

A

Symptomatically

NO immediate cure

45
Q

What lifestyle interventions help in OAB?

A 
Normalise fluid intake
Reduce caffeine, fizzy drinks, chocolate
Stop smoking
Wt loss
Bladder training programme
46
Q

What is involved in the bladder training programme?

A

Timed voiding with gradually increased intervals

Attempts to re-establish cortical control over detrusor

47
Q

What drugs can you use to Rx OAB?

A

Antimuscarinics (e.g. solifenacin, fesoteridine, oxybutynin oral options, kentera patches are transdermal)
TCAs, e.g. imipramine

48
Q

What procedures can you offer for OAB?

A 
Botulinium toxin (A and B) - lasts for 6-9m
CISC - clean intermittent self catheterisation 
Neuromodulation - needle stimulation of S2-4 (--> reflex inhibition of detrusor muscle)

Reproduction (28 decks)

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