Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gwen - Reproductive Medicine (Obs, Gyn, Breast) > Female urinary incontinence > Flashcards

Female urinary incontinence Flashcards

1
Q

LOOK AT YOUR NOTES

A

LOOK AT YOUR NOTES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What part of the nervous system controls the external urethral sphincter?

A

Somatic nervous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the approximate volume at which the sensation of needing to void becomes apparent?

A

Approximately 200 mls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are reversible causes of urinary incontinence?

A
  • UTI
  • Delerium
  • Medications - diuretics, anticholinergics
  • Constipation - leading to faecal impaction
  • Polyuria
  • Urethral irritability - vaginal atrophy
  • Prolapse
  • Bladder stones and tumours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are irreversible (but treatable) causes of urinary incontinence?

A
  • Prostatic hypertrophy - overflow incontinence
  • Overactive bladder syndrome/detrusor overactivity
  • Stress incontinence - pelvic muscle weakness
  • Fistula - bladder to vagina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What environmental factors can increase the risk of incontinence?

A
  • Bed bound
  • Reduced mobility
  • Where the toilet is/ease of access
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What would you ask about when assessing urinary incontinence?

A
  • Urgency symptoms - time between needing to go and voiding, know when they need to pass urine
  • Stress symptoms -laughing, weight lifting
  • Obstructive symptoms - force, hesitancy, dribbling
  • Polyuria
  • Dysuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the symptoms of stress incontinence?

A

Urine leak on movement, coughing, laughing, squatting, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How would you evaluate someone with stress incotinence?

A
  • Examination
  • Dipstick
  • General bloods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What medical treatment would you use to treat stress incontinence?

A
  • Physio - pelvic floor exercises
  • Oestrogen cream
  • Duloxetine - SSRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What surgery can be used to correct stress incontinence if no other treatment has worked?

A

TVT/colposuspension - 90% cure at 10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the features of urge incotinence?

A
  • Urgency - may have incontinence
  • Frequency
  • Nocturia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can cause urge incontinence?

A
  • Bladder Stones
  • Stroke/Parkinsons
  • UTI
  • Diabetes
  • Atrophic vaginitis
  • Urethritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How would you treat urge incontinence?

A

https://cks.nice.org.uk/incontinence-urinary-in-women#!scenario:1

  1. Lifestyle advice - reduce caffeine, stop smoking, lose weight
  2. Bladder retraining
  3. Anti-cholinergics - Oxybutinin, tolterodine, darifenacin
  4. Nocturia - Consider desmopressin
  5. Vaginal atrophy - oestrogen cream

​If these fail - refer to 2o care for other options - Botulinum toxin A, percutaneous sacral nerve stimulation, cystoplasty, and urinary diversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are characteristics of urinary retention with overflow incontinence?

A
  • Poor urine flow
  • Double voiding
  • Hesitancy
  • Post micturition dribbling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What can cause raised residual bladder volume in an elderly patient?

A
  • Prostatic hypertrophy
  • Urethral stricture
  • Bladder diverticulum
  • Pelvic organ prolapse - female only
  • Hypocontractile detrusor
  • Bladder tumour
  • Drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a neuropathic bladder?

A

An underactive bladder secondary to neurological disease, typically MS or stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does a neuropathic bladder present?

A

Overflow incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How would you treat a neuropathic bladder?

A

Catheterisation is the only treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How would you assess urinary incontinence?

A
  1. Physical examination
  2. Urine Dipstick +/- MSSU
  3. Bladder scan - residual volume
  4. QOL assessment and Bladder Diary
  5. Urodynamic studies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What information can be gained from a bladder diary?

A
  • 24 hr urine output
  • Number and severity of inconitnence episodes
  • Max/minimum voided volumes
  • Diurnal variation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When is bladder retraining indicated?

A

Overactive bladder syndrome

23
Q

When is pelvic floor training indicated?

A

Stress incontinence

24
Q

When would the use of antimuscarinics such as oxybutinin be indicated in urinary incontinence?

A

Overactive bladder/Urge incontinence

25
Q

When would performing a surgical TURP be indicated?

A

Urinary Retention with overflow incontinence/outflow obstruction - when the medications have not worked

26
Q

When would a TVT operation be considered?

A

Stress incontinence - when medications and physiotherapy have failed to work

27
Q

When would culposuspension be indicated in urinary incontinence?

A

Stress incontinence - if medical management fails - GOLD STANDARD

28
Q

When would duloxetine be indicated in urinary incontinence?

A

Stress incontinence

29
Q

When would oestrogen cream be indicated for in urinary incontinence?

A

Stress incontinence

30
Q

When would regular toileting be indicated for in urinary incontinence?

A
  • Dementia
  • Urge incontinence
31
Q

What are the indication for catheter insertion?

A
  • Symptomatic urinary retention
  • Outflow obstruction + renal failure/hydronephrosis
  • AKI - accurate urine monitoring
  • Intensive care
  • Sacral pressure sores + incontinence
  • Other methods cause stress to a frail individual
32
Q

When is the insertion of a catheter not indicated?

A
  • Immobility - even from stroke
  • Heart failure
  • Monitoring fluid balance in a continent patient
  • Nursing convenience
  • Asymptomatic chronic retention - refer to urology first
33
Q

How could you manage urinary incontinence which is still present after treating reversible cause without the use of a catheter?

A
  • Environmental modification
  • Regular/individual toileting programme
  • Pad/pants
  • Drainage sheath/condom catheter
  • Intermittent catheterisation
34
Q

When should you consider refering to urology for urinary incontinence?

A

After failure of initial management (max 3 months of pelvic floor exercises, cone therapy, habit retraining and/or appropriate medication)

35
Q

How would you manage a blocked catheter?

A
  • Consider cause - stones, infection, sediment, constipation, bladder tumour
  • Remove and replace
  • Maintain good fluid intake
  • Consider saline washouts - if sediment
36
Q

How would you manage someone who’s catheter was bypassing?

A
  • Consider cause - irriation of bladder causing contraction, infection, sphincter incompetence from long term catheterisation
  • Exclude blockage
  • If no residual - reduce catheter diameter
37
Q

How would you manage someone with a catheter infection?

A
  • Send urine culture
  • Remove catheter where possible
  • Ensure adequate hydration
  • Abx - as narrow pectrum as possible once cultures received
38
Q

How would you decide if it was appropriate to treat a catheter infection?

A

Only treat if clinically significant infection - Fever, malaise, delerium, pain, abnormal inflammatory markers

Remember - dark, cloudy, smelly urine does not always indicate infection - more commonly dehydration

39
Q

What part of the autonomic nervous system causes contraction of the neck of the bladder and the internal urethral sphincter?

A

Sympathetic Nervous System - a-adrenoreceptor

40
Q

What part of the autonomic nervous system causes contraction of the bladder?

A

Parasympathetic Nervous System

41
Q

What part of the autonomic nervous system controls relaxation of the bladder?

A

Sympathetic - ß - adrenoreceptor

42
Q

What is stress incontinence?

A

Involuntary leakage on effort or exertion, on sneezing or coughing. Most commonly due to a weak bladder outlet

43
Q

What is urge incontinence?

A

Involuntary leakage accompanied by or immediately preceded by urgency (immediate need)

A symptom complex usually, but not always, related to urodynamically demonstrable detrusor overactivity (DO)

44
Q

What is urinary retention with overflow incontinence?

A

This is where the outlet of the bladder does not relax properly, or the detrusor muscle is too weak. Over time, urine builds up within the bladder and causes incontinence due to overflow

45
Q

What spinal levels are involved in storage of urine?

A

T10 - L2 (hypogastric nerve)

46
Q

What spinal levels are involved in voiding and voluntary sphincter control?

A

S2-S4 (pelvic and puedendal nerves)

47
Q

What would you look for on examination of someone with features of stress incontinence?

A
  • Examine pelvic floor for:
    • Weaknesses
    • Prolapse
    • Pelvic masses
  • Look for leaking with full bladder on standing
48
Q

What are risk factors for the development of stress incontinence?

A
  • Obesity
  • Pregnancy
  • Post-menopause
49
Q

How might you assess if incontinence is being caused by retention with overflow?

A
  • Palpate bladder post voiding
  • Post void bladder scan
50
Q

In terms of figuring out what is causing urinary incontinence, what might you want to exclude?

A
  • Neurological comorbidity - Parkinsons, Stroke, MS
  • Faecal impaction - Digital RE
51
Q

How would you investigate urge incontinence?

A

Urodynamic studies

52
Q

What is involved in a bladder diary?

A

A diary that records times and amounts of urine passed, leakage episodes, pad usage and other information such as fluid intake, degree of urgency and degree of incontinence. A bladder diary should cover variations in the usual activities, such as both working and leisure days.

This is normally taken over a period of 3 days

53
Q

What investigation would you consider doing first in a woman presenting with incontinence?

A

Urine dipstick

Gwen - Reproductive Medicine (Obs, Gyn, Breast) (49 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions