female urinary incontinence Flashcards
urinary incontinence (UI)
any involuntary leakage of urine
stress urinary incontinence (SUI)
involuntary leakage on effort or exertion, on sneezing or coughing
urge urinary incontinence (UUI)
involuntary leakage accompanied by or immediately preceded by urgency
mixed urinary incontinence (MUI)
involuntary leakage accompanied by or immediately preceded by urgency and on effort on exertion, or sneezing/coughing
impact of UI
impair QI
reduce social relationships and activities
impair emotional and psychological wellbeing
impair sexual relationships
embarrassment and diminished self esteem
UI risk factors
age parity menopause smoking inc abdominal pressure pelvic floor trauma denervation connective tissue disease surgery
main risk factor for SUI: pregnancy and childbirth
patient assessment: history
age, parity, mode of deliveries, weight heaviest babies, smoking HRT
medical conditions: DM, anti-htn drugs, glaucoma
patient symptoms
irritation symptoms:
- urgency
- inc daytime and nighttime frequency
- dysuria
- haematuria
incontinence symptoms:
- stress UI
- urgency UI
- coital incontinence
- severity - how many pads a day
3 days urinary diary
fluid intake: quantity and quality urine output nocturia avg voided volume also urine dipstick
examination of woman with bladder/pelvic floor problems
general abdominal neurological gynaecological pelvic floor assessment prolapse stress incontinence uro-genital atrophy changes pelvic mass pelvic floor tone, strength, awareness
investigations
urinalysis: multistix +/- MSSU
post-voiding residual volume assessment (usually by bladder scanning) if symptoms voiding difficulty
urodynamics if surgical Rx contemplated
management: lifestyle changes
stop smoking
lose weight
eat more healthily to avoid constipation
stop drinking alcohol and caffeine
management: pelvic floor muscle training
reinforcement of cortical awareness of muscle groups
hypertrophy of existing muscle fibres
general increase in muscle tone and strenth
pharmacological management
yentreve (TM)
(duloxetine)
first and only drug liscened for Rx moderate to severe stress urinary incontinence
who should receive duloxetine
primary care: if PFMT failed or would be enhanced by it
secondary care:
- do not wish surgery
- not fit for surgery
- after failed surgery
- patient’s family not complete
surgical management
retro-pubic RVT (1st choice)
colposuspension
overactive bladder syndrome
symptom complex, usually relate to urodynamically demonstable detrusor overactivity
defining symptoms: urgency (with/without urge incontinence), usually with frequency and nocturia
causes of overactive bladder syndrome
detrusor activity (mostly)
urethrovesical dysfunction
risk factors for urge incontinence
advanced age
diabetes
UTIs
smoking
OAB conservative management
lifestyle interventions
- normalise fluid intake
- reduce caffeine, fizzy drinks, chocolate
- stop smoking
- weight loss
bladder training programme
- timed voiding with gradually increasing intervals - continence nurse
- timed bladder emptying programme
OAB pharmacological treatment
anti-muscarinic: oral or transdermal
tri-cyclic antidepressants (imipramine)
botox
neuromodulation
