Female urinary incontinence Flashcards
Describe the innervation of the urethral sphincters.
Pudendal nerve
S2-S4 somatic
Voluntnary
What are the keys to bladder emptying?
Detrusor contraction
Urethral relaxation
Sphincter co-ordination
Absence of obstruction or anatomical shunts
What is urinary incontincence?
Any involuntary leakage of urine
What is SUI?
Stress urinary incontinence
Involuntary leakage on effort or exertion including sneezing or coughing
What is UUI?
Urge urinary incontinence
Involuntary leakage accompanied by urgency
What are some consequences of UI?
Reduce social relationships
Emotional and psychological damage
Impair sexual relationships
Embarrassment and diminished self-esteem
What are some risk factors for female urinary incontinence?
Age Parity Menopause Smoking Pelvic floor trauma Denervation Connective tissue disease Surgery
What kind of medications could be a risk factor for urinary incontinence?
Anti-hypertensives
Anti-depressants
Anti-psychotics
What are some conditions which could pre-dispose a patient to urinary incontinence?
DM
Glaucoma
Heart/kidney/liver problems
Previous PFMT
How could you asses the effect of urinary incontinence on QoL?
“How much does Urinary leakage interfere with your day to day activities?”
What factors would a 3 day urinary diary include?
Fluid intake (quality and quantity) Urine output Daytime frequency Nocturia Average voided volume
What are some considerations in the examination of the women with bladder/ pelvic floor problems?
Prolapse Stress incontinence Uro-genital atrophy changes Pelvic mass (space occupying lesion) Pelvic floor tone, strength, awareness
What are some useful investigation for bladder/ pelvic floor problems?
Urinalysis
Post voiding residual volume assessment
USS
How is PDet calculated?
On cystometry result
PAbd subtracted from PVes
Are there any medical solutions to SUI?
Duloxetine
Approved for restricted use for moderate to severe SUI
Why may duloxetine be prescribed?
If PFMT has failed or would be enhanced
Patient does not want
surgery
Failed surgery
What is TVT?
Tension-free vaginal tape
Minimally invasive procedure to reinforce the structures supporting the urethra
Is TVT as effective as colposuspension?
Yes
What is OAB?
Overactive bladder syndrome
A symptom complex usually, but not always, related to urodynamically demonstrable detrusor overactivity (DO)
What are some common risk factors for urge incontinence?
Advanced age
Diabetes
UTI
Smoking
What are some useful lifestyle interventions for OAB management?
Normalise fluid intake
Reduce caffeine, fizzy drinks, chocolate
Stop smoking
Weight loss
What is bladder retraining?
The re-establishment of cortical control over detrusor function and voiding
Achieved by timed bladder emptying programme
What kinds of drugs could be used to treat OAB?
Antimuscarinic
Tri-cyclic antidepressants
What are some benefits of neuromodulation to treat OAB?
Cheap
Minimally invasive
70% improvement in Refractory OAB
