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Reproductive System > Female Urinary Incontinence > Flashcards

Female Urinary Incontinence Flashcards

1
Q

What are the major risk factors for developing Urinary Incontinence?

A

Age

Parity

Menopause

Smoking

Pelvic Floor Trauma

Denervation

Connective tissue disease

Surgery

Preg and childbirth!

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2
Q

What do you want to know about incontinence?

A
  • Irritation symptoms
    • Frequency, urgency, nocturia, dysuria and haematuria
  • Incontinence and what type e.g. stress, urgency, coital and severity of incontinence
  • Voiding symptoms
    • Straining, interruption and UTIs
  • Fluid intake: quantity and content
  • Prolapse symptoms e.g. lump, heaviness or draggin sensation
  • Bowel symptoms e.g. incontinence, constipation of IBS
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3
Q

What tests can you do for an incontinent woman?

A

HISTORY AND EXAM FIRST

  • 3 day urinary diary
  • Urine dipstick
  • Exams (general, abdo, neuro, pelvic)
  • Pelvic floor Assessment
  • Bladder Scan (Residual volume)
  • Urodynamics (if considering surgery)
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4
Q

How do we grade a pelvic floor assessment?

A

Oxford Scale

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5
Q

In what ways can we manage incontinence?

A
  • Lifestyle (Smoking, weight loss, healthy eating to prevent constipation, alcohol and caffeine)
  • Medical
  • Physio
  • Surgery
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6
Q

Define Stress Urinary Incontinence?

A

Intrabdominal pressure exceeds urethral pressure –> Leakage on coughing, straining, sneezing etc

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7
Q

How can we increase the closure pressure of the urethra in stress incontinence?

A
  • Pelvic floor training/PHYSIO
  • Surgery
  • Meds (Duloxetine - after muscle training and surgery)
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8
Q

What surgery can we provide for stress incontinence?

A

Tension Free Vaginal Tape

Colposuspension

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9
Q

Define Overactive Bladder Syndrome

A

Symptom complex usually due to Detrusor Overactivity:

  • Urgency +/- urge incontinence
  • Frequency
  • Nocturia

DO is a urodynamic parameter characterised by involuntary detrusor contractions during filling that are either spontaneous or provoked. DO is further qualified as neurogenic when there is a relevant neurologic condition or idiopathicwhen there is no defined cause

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10
Q

What risk factors apply specifically to Urge Incontinence?

A

Advanced age (35-55yrs)

Diabetes

Urinary tract infections

Smoking

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11
Q

How do we manage OAB?

A

Lifestyle:

  • Normalize fluids
  • Lower caffeine, fizzy and chocolate
  • Smoking cessation
  • Wt loss

Bladder Retraining Meds

New stuff includes botox and neuromodulation

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12
Q

How does bladder retraining work?

A

Times voiding with increasing intervals to re-estrablish cortical control over the detrusor

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13
Q

So what medications are available for OAB?

A

Antimuscarinincs e.g. Oxybutinin

Tri-cyclic antidepressants (imipramine)

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14
Q

How does the mechanism of bladder filling work?

A
  1. Sympathetic system activated (encourages storage)
  2. Inhibition of parasympathetic
  3. Mediates contraction of bladder base and proximal urethra
  4. Inhibition of contraction by gradual awareness of filling
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15
Q

How does the bladder emptying system work

A

Inhibition of sympathetic pathway Activation of parasympathetic pathway Detrusor contaction Urethral relaxation Absence of obstruction

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16
Q

Define urgency

A

The complaint of a sudden, compelling desire to pass urine that is difficult to defer

17
Q

Define urge incontinence

A

The complaint of involuntary leakage of urine accompanied or immediately preceded by urgency

18
Q

Define stress incontinence

A

Involuntary leakage on effort or exertion, on sneezing or coughing

19
Q

define mixed urinary incontinence

A

Involuntary leakage accompaniend by or immediately preceded by urgency

20
Q

What is the only drug licensed for treatment of stress urinary incontinence?

A

Yentreve (duloxetine)

Primary Care:

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

Secondary Care:

  • Does not wish surgery
  • Not fit for surgery
  • After failed surgery
  • When the patient’s family is not complete
21
Q

What is colposuspencion surgery for SUI?

A

An operation to treat stress incontinence by lifting the bladder and changing its position. This lift helps to prevent leakage by improving pressure transmission and compression of the neck of the bladder.

22
Q

Describe the 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

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

23
Q

What pelvic nerves innervate the bladder?

A
  • Hypogastric (sympathetic) nerves - T10-L2 (storage)
  • Pelvic nerve (parasympathetic) - S2-4 (voiding)
  • Pudendal nerve (somatic) - S2-4 (voluntary)

Reproductive System (26 decks)

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