Female urinary incontinence Flashcards
What is the upper urinary tract?
- pressure is?
kidneys and ureter
- low pressure distensible conduit with intrinsic peristalsis
what does the UUT DO?
Transport urine from nephrons via ureters to the bladder.
What is the lower urinary tract?
Bladder & Urethra
rate of bladder filling is?
- storage of urine pressure is?
- 5-5 mls/min
- low
what is the Vesico-ureteric mechanism?
protects the nephrons from any damage secondary to retrograde transmission of back pressure or infection from the bladder
nerve supply to the bladder?
- for storage
- voiding
- voluntary
pelvic nerves
- hypogastric nerve (sympathetic T10-L2)
- pelvic nerve - parasympathetic S2-4
- pudendal nerve - S2-S4 - voluntary
bladder filling - what does it have to do?
Accommodate increasing volume at constantly low pressure.
cortical activity means what in terms of bladder filling ? (3)
Activating a reciprocal guarding reflex
- Rhabdosphincter contraction
- increase sphincter contraction & resistance.
Cortical activity activates and mediates what 3 things?
- Activates Sympathetic pathway &
- Reciprocal inhibition of the Parasympathetic pathway
- Mediates contraction of bladder base and proximal urethra
Bladder emptying is due to what contraction and what relaxation?
- needs co-ordination of what?
- needs the absence of?
- Detrusor
- Urethral
- Sphincter
- Obstruction or anatomical shunts (Cystocele, Diverticulum)
what is the cortical influence off bladder emptying (pathways affected)? - what micturition centre is it?
- Pontine
- Activation of parasympathetic pathway & Inhibition of Sympathetic pathway
what % of women between age 15-60 report UI?
10-25%
what are the impacts of UI?
- impair the QoL.
- Reduce social relationships and activities.
- Impair emotional and psychological well- being.
- Impair sexual relationships.
- Embarrassment and diminished self- esteem.
Risk factors of UI?
Age Parity Menopause Smoking Medical problems Inc Intra abdo pressure Pelvic floor trauma Denervation Connective tissue disease Surgery
what is the main risk factor for SI?
Pregnancy & Childbirth
What are crucial history questions to ask a female presenting with UI?
Age, parity, mode of deliveries, weight of heaviest baby, Smoking, HRT,
Medical conditions to ask about in UI history?
DM, anti-HTN medications, Glaucoma, Heart/Kidney/Liver problems, Cognitive problems, Anti-depressants/ anti-psychotics.
what may be irritation symptoms someone presents with?
Urgency ; Sudden compelling desire to void that is difficult to defer.
- Increased daytime frequency (>7)
- Nocturia (>1)
- Dysuria
- Haematuria ☻
what is urgency usually associated with? (5)
with frequency, nocturia and urgency incontinence
what are incontinence symptoms? (4)
- Stress UI
- Urgency UI
- Coital Incontinence
- Severity: How many pads/ day?
what are voiding symptoms?
Straining to void
Interrupted flow
Recurrent UTI ☻
scale of how much Urinary leakage affects day to day activities
0 -10
what are prolapse symptoms (3)
Vaginal Lump/ Dragging sensation in vagina
what are bowel symptoms? (4)
Anal Incontinence, Constipation, faecal evacuation dysfunction, IBS.
patient assessment - feature (5)
- test u may do?
- Fluid intake: Quantity & Quality
- Urine Out-Put (exclude Nocturnal Polyuria)
- Daytime Frequency,
- Nocturia
- Average voided volume.
urine dipstick
Examination of the women with Bladder/ Pelvic floor problems (5 types)
- General
- Abdominal
- Neurological
- Gynaecological
- Pelvic floor assessment (Oxford Scale)
Examination of the women with bladder/ pelvic floor problems - what are you looking for?
- Prolapse
- Stress incontinence
- Uro-genital atrophy changes
- Pelvic mass (space occupying leasion)
- Pelvic floor tone, strength, awareness
Investigations you can carry out?
- Urinalysis: Multistix +/- MSSU
- Post voiding residual volume assessment (usually by bladder scanning) only If symptoms of voiding difficulties.
- Urodynamics: ONLY indicated if surgical treatment is contemplated.
Management of UI?
- Lifestyle changes - stop smoking, weight loss, eat healthy to avoid constipation, avoid caffeine and alcohol
- Medical treatments
- Physiotherapy
- Surgery
When does stress urinary incontinence occur?
intra-abdominal pressure exceeds urethral pressure, resulting in leakage
urethral closure pressure is increased by? (3)
- pelvic floor muscle training
- surgery
- pharmacological agents
Why should you carry out pelvic floor muscle training?
- reinforcement of cortical awareness of muscle groups
- hypertrophy of existing muscle fibres
- general increase in muscle tone and strength
what is the only drug licensed for severe stress incontinence?
duloxetine
who should receive duloxetine
if PMFT has failed
- they do not want surgery
- failed surgery
- not fit for surgery
why do stress and urge incontinence arise?
anatomical defect in the anterior vaginal wall & pubo-urethral ligament (PUL).
- Urethral/bladder neck closure dysfunction and USI
what laxity might result in stimulation of bladder neck stretch receptors?
- what may this provoke?
Suburethral Hammock
- a premature micturition reflex and Urgency Incontinence
what is a minimally invasive procedure used to reinforce the structures supporting the urethra?
Tension-free vaginal tape (TVT)
what is the only drug licensed for severe stress incontinence?
duloxetine
who should receive duloxetine
if PMFT has failed
- they do not want surgery
- failed surgery
- not fit for surgery
why do stress and urge incontinence arise?
anatomical defect in the anterior vaginal wall & pubo-urethral ligament (PUL).
- Urethral/bladder neck closure dysfunction and USI
what laxity might result in stimulation of bladder neck stretch receptors?
- what may this provoke?
Suburethral Hammock
- a premature micturition reflex and Urgency Incontinence
TVT Vs Colposuspension
TVT is as effective as Colposuspension for the treatment of primary USI up to 2 years.
First choice treatment for SUI?
TVT
What is Overactive Bladder Syndrome (ICS Definition)?
symptom complex usually, but not always, related to urodynamically demonstrable detrusor overactivity (DO)
defining symptoms
urgency (with/without urgency incontinence), usually with frequency and nocturia
what is urge incontinence?
The complaint of involuntary leakage of urine accompanied or immediately preceded by urgency
Describe what DO is like?
involuntary detrusor contractions during filling
- spontaneous or provoked
- neurogenic when there is a relevant neurologic condition or idiopathic when there is no defined cause
prevalence of OAB?
increases with age, and is slightly higher in women
Risk Factors for Urge Incontinence? (4)
- Advanced age
- Diabetes
- Urinary tract infections
- Smoking
OAB is a..?
chronic condition
what is nocturia?
Usually accompanies urgency with or without urge incontinence and is the complaint that the individual has to wake at night one or more times to void
OAB conservative management - lifestyle interventions
- Normalise fluid intake
- Reduce caffeine, Fizzy drinks, Chocolate
- Stop Smoking
- Weight loss
what is a bladder training programme?
Timed voiding with gradually increasing intervals - Continence nurse
what treatment is used for OAB?
Antimuscarinic
Oral treatment options for OAB?
Solifenacin (Vesicare 5-10mg ) Fesoteridine (Toviaz 4-8 mg) Trospium Chloride (60mg XL) Darifencain (Emselex 7.5-15 mg ) – Constipation; FI Lyrinel XL (10-20 mg ) Oxybutinin (5-10 mg/ tds)
Transdermal treatement for OAB?
Kentera Patches
Tri-cyclic antidepressants for OAB include?
Imipramine
anticholinergic agents currently used In the UK for OAB?
atropine, propantheline,
trospium chloride, and propiverine, a calcium antagonist and anticholinergic
Recent advances - drugs and methods for OAB? 2 TYPES - what are they and what do they do
Botulinum Toxin (A&B) NDO/ IDO
- Neuromodulation
Needle stimulation (S2-4)
Reflex Inhibition to the Detrusor muscle
