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Reproductive System > Female Urinary Incontinence > Flashcards

Female Urinary Incontinence Flashcards

1
Q

What is the function of the vesico-ureteric valve and what is the result of it’s dysfunction?

A

To allow urine to move from the upper urinary tract to the lower tract only
Dysfunction leads to vesico-ureteric reflux

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2
Q

What are the normal values for bladder capacity and urination?

A

Normal bladder capacity is ~ 1 pint
~½ pint volume at which there is a desire to urinate
~¼ pint where the first sensation of there being something in the bladder is felt

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3
Q

What is necessary to allow bladder emptying to occur?

A
  • Detrusor contraction.
  • Urethral Relaxation.
  • Sphincter co-ordination.
  • Absence of Obstruction or anatomical shunts
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4
Q

What is the definition of urinary incontinence?

A

Any involuntary leakage of urine

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5
Q

What is the definition of stress urinary incontinence?

A

Involuntary leakage on stress or exertion (sneezing, coughing etc)

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6
Q

What is the definition of urge urinary incontinence?

A

Involuntary leakage accompanied by or immediately preceded by urgency

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7
Q

What is the definition of mixed urinary incontinence?

A

Involuntary leakage accompanied by or immediately preceded by urgency and on effort or exertion

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8
Q

What is the incidence of urinary incontinence?

A

10-25% of women aged 15-60 report urinary incontinence
Up to 40% of women in the community aged over 60 reporting incontinence
~50% of women in nursing homes experience incontinence

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9
Q

How does the incidence of incontinence vary with age?

A

Prevalence of urinary incontinence increases with age, with stress incontinence being more common in the young-middle aged and urge incontinence more common in the elderly.

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10
Q

What is the impact of urinary incontinence?

A
  • UI may significantly impair the QoL.
  • Reduce social relationships and activities.
  • Impair emotional and psychological well- being.
  • Impair sexual relationships.
  • Embarrassment and diminished self- esteem
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11
Q

What are the risk factors for urinary incontinence?

A
  • Pregnancy and childbirth (Main risk factors)
  • Age
  • Parity
  • Menopause
  • Smoking
  • Medical problems
  • Increased intra-abdominal pressure
  • Pelvic floor trauma
  • Denervation
  • Connective tissue disease
  • Surgery
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12
Q

What specific enquiries should be made when taking a history regarding incontinence?

A
  • Age, parity, mode of deliveries, weight of heaviest baby, Smoking, HRT
  • Medical Conditions: DM, anti-HTN medications, Glaucoma, Heart/Kidney/Liver problems, Cognitive problems, Anti-depressants/ anti-psychotics.
  • Previous PFMT, Surgical treatment of SUI or POP
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13
Q

What symptoms can be associated with incontinence that suggest an irritative disease?

A
  • Urgency ; Sudden compelling desire to void that is difficult to defer.
  • Increased daytime frequency (>7)
  • Nocturia (>1)
  • Dysuria
  • Haematuria
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14
Q

How do normal number of voids vary with age?

A

Up to the age of 70, up to 7 daytime voids and one nighttime is normal. At 70, the normal number of voids increases by one with each decade of life (eg 8 daytime and 2 nighttime in 70s, 9 and 3 in 80s).

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15
Q

What are the potential incontinence symptoms?

A
  • Stress UI
  • Urgency UI
  • Coital Incontinence
  • Severity: How many pads/ day?
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16
Q

What voiding symptoms can be associated with incontinence?

A
  • Straining to void
  • Interrupted flow
  • Recurrent UTI
17
Q

What prolapse symptoms can be associated with incontinence?

A

Vaginal lump

Dragging sensation in the vagina

18
Q

What bowel symptoms can be associated with incontinence?

A

Anal incontinence
Constipation
Faecal evacuation dysfunction
IBS

19
Q

What urine tests can be useful in incontinence?

A

Patient assessment can include a urine dipstick and a three-day urine diary detailing information on the following:
• Fluid intake: Quantity & Quality
• Urine Out-Put (exclude Nocturnal Polyuria)
• Daytime Frequency,
• Nocturia
• Average voided volume

20
Q

What examinations can be done with bladder or pelvic floor problems?

A 
•General
•Abdominal
•Neurological
•Gynaecological
•Pelvic floor assessment
Can also check for:
•	Prolapse
•	Stress incontinence
•	Uro-genital atrophy changes 
•	Pelvic mass (space occupying leasion)
•	Pelvic floor tone, strength, awareness
21
Q

What investigations can be useful in incontinence?

A
  • Urinalysis- Dip stick +/- MSSU
  • Post voiding residual volume assessment if symptoms of voiding difficulties (usually by bladder scan)
  • Urodynamics- only indicated if surgical intervention being contemplated
22
Q

What forms the basis of management of incontinence?

A
  • Lifestyle changes
  • Medical treatments
  • Physiotherapy
  • Surgery
23
Q

What lifestyle changes can aid in stress incontinence?

A
  • Stop smoking
  • Lose weight
  • Eat more healthily to avoid constipation
  • Stop drinking alcohol and caffeine
24
Q

Which patients should receive conservative management of incontinence?

A

All patients with urinary incontinence should receive conservative management unless they wish otherwise, it has failed before or there are not facilities

25
Q

What does pelvic floor muscle training encourage?

A
  • Reinforcement of cortical awareness of muscle groups
  • Hypertrophy of existing muscle fibres
  • General increase in muscle tone and strength
26
Q

What medical management can be given for stress incontinence?

A

Duloxetine for stress incontinence, in conjunction with PFMT
Can be given in primary care if conservative management has failed or would be enhanced by duloxetine
Can be given in secondary care if:
• Patient does not wish to have surgery
• Patient is not fit for surgery
• After failed surgery
• Patient has not finished having children

27
Q

What surgical management can be given for stress incontinence?

A

Tension-free vaginal tape first line surgical option for stress incontinence
Associated with 80% cure rate

28
Q

What are the symptoms of overactive bladder syndrome?

A

Urgency (with or without urge incontinence), usually with frequency and nocturia.

29
Q

What are the risk factors for urge incontinence?

A
  • Advanced age
  • Diabetes
  • Urinary tract infections
  • Smoking
  • Parity
30
Q

What is involved in conservative management of urge incontinence?

A 
Normalise fluid intake
Reduce caffeine, Fizzy drinks, Chocolate
Stop Smoking 
Weight loss
Bladder retraining (timed voiding with gradually increasing intervals)
31
Q

What is involved in pharmacological management of urge incontinence?

A 
Anti-muscarinics (solifenacin, fesoteridine, trospium)
Tricylcic antidepressants (imipramine, amitriptyline)

Reproductive System (30 decks)

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