Female Urinary Incontinence Flashcards
What is the function of the vesico-ureteric mechanism?
Protects the nephrons from any damage secondary to retrograde transmission of back pressure or infection from the bladder
Which nerves supply the bladder?
- Hypogastric nerve (symp.): storage
- Pelvic nerve (para): voiding
- Pudendal nerve (somatic): voluntary
What are the steps of bladder emptying?
- Detrusor contraction
- Urethral relaxation
- Sphincter coordination
- Absence of obstruction
What is stress urinary incontinence?
Involuntary leakage on effort, exertion, sneezing or coughing
What is urge incontinence?
Involuntary leakage accompanied by or immediately preceded by urgency
What is mixed incontinence?
Involuntary leakage with features of urge and stress incontinence
What are the risk factors for incontinence?
- Age
- Parity
- Menopause
- Smoking
- Medical problems
- Increase intra abdo pressure
- Denervation
- Connective tissue disease
- Surgery
Name the irritation symptoms of incontinence
- Urgency
- Increased daytime frequency
- Nocturia
- Dysuria
- Haematuria
Name the symptoms of incontinence
- Stress
- Urgency
- Coital incontinence
- ?severity
- Straining to void
- Interrupted flow
- Recurrent UTI
How can incontinence be assessed?
- 3 day urinary diary
- Urine dipstick
- Examination
- Post voiding residual volume assessment - bladder scanning
- Urodynamics
How can incontinence be managed?
- Lifestyle changes (smoking, weight, diet, alcohol and caffeine)
- Medical treatments
- Physio
- Surgery
- Tension free vaginal tape
How can stress incontinence be managed?
- Pelvic floor muscle training
- Surgery: colposuspension
- Pharmacological agents: duloxetine
What are the symptoms of overactive bladder syndrome?
- Urgency +/- incontinence
- Frequency
- Nocturia
What are the risk factors for urge incontinence?
- Advanced age
- Diabetes
- UTIs
- Smoking
How can overactive bladder be managed?
-Treat symptoms
Normalise fluid intake
-Reduce caffeine, fizzy drinks and chocolate
-Weight loss
-Bladder training programme
-Drugs: anti-muscarinics (e.g. solifenacin) and tri-cyclic antidepressants
-Newer treatments: botox and neuromodulation
