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Reproductive System > Female Urinary Incontinence > Flashcards

Female Urinary Incontinence Flashcards

1
Q

What are the 2 parts of the urinary tract?

A
  • Upper urinary tract
    • Ureters and kidneys
    • Low pressure distensible conduit with intrinsic peristalsis
    • Transports urine from nephrons via ureters to bladder
  • Lower urinary tract
    • Bladder and urethra
    • Bladder fills at rate of 0.5-5mls/min
    • Low pressure storage of urine
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2
Q

What is the upper urinary tract composed of?

A
  • Ureters and kidneys
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3
Q

What is the lower urinary tract composed of?

A
  • Bladder and urethra
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4
Q

The bladder fills at what rate?

A
  • Bladder fills at rate of 0.5-5mls/min
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5
Q

What nerves supply the bladder?

A
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6
Q

How does the bladder accomodate increasing volume at constantly low pressure?

A
  • Accommodates increasing volume at constantly low pressure by inhibition of contractions by giving gradual awareness to filling
  • Cortical activity to allow this, activates reciprocal guarding reflex by Rhabdosphincter contraction, increasing sphincter contraction and resistance
    • Activates sympathetic pathway and reciprocal inhibition of parasympathetic pathway, mediates contraction at bladder base and proximal urethra
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7
Q

How is bladder emptying achieved?

A
  • Requires detrusor contraction, urethral relaxation, sphincter co-ordination, absence of obstruction or shunts
  • Cortical activity
    • Pontine micturition centre
    • Activation of parasympathetic pathway and inhibition of sympathetic pathway
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8
Q

What is urinary incontinence (UI)?

A

Any involuntary leakage of urine

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9
Q

What is stress urinary incontinence (SUI)?

A
  • Involuntary leakage on effort or exertion, on sneezing or coughing
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10
Q

What is urge urinary incontinence (UUI)?

A
  • Involuntary leakage accompanied by or immediately preceded by urgency
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11
Q

What is mixed urinary incontinence (MUI)?

A
  • Involuntary leakage accompanied by or immediately preceded by urgency and on effort or exertion, or on coughing or sneezing
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12
Q

What are the different kinds of urinary incontinence?

A
  • 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 or exertion, or on coughing or sneezing
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13
Q

What is the aetiology of female urinary incontinence?

A
  • Anatomical defect in the anterior vaginal wall and pubo-urethral ligament
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14
Q

What is the prevalence of female urinary incontinence?

A
  • 10-25% of woman age 15-60
  • 15-40% of woman over 60
  • Prevalence increases with age
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15
Q

What are risk factors for female urinary incontinence?

A
  • Age
  • Parity
  • Menopause
  • Smoking
  • Medical problems
  • Increased abdominal pressure
  • Pelvic floor trauma
  • Denervation
  • Connective tissue disease
  • Surgery
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16
Q

What is the presentation of female urinary incontinence?

A
  • Irritation symptoms
    • Urgency (sudden compelling desire to void)
    • Increased daytime frequency (>7)
    • Nocturia (>1)
    • Dysuria
    • Naematuria
  • Incontinence symptoms
    • Stress UI
    • Urgency UI
    • Coital incontinence (during sexual intercourse)
  • Voiding symptoms
    • Straining to void
    • Interrupted flow
    • Recurrent UTI
  • Prolpase symptoms
    • Vaginal lump, dragging sensation in vagina
  • Bowel symptoms
    • Anal incompetence
    • Constipation
    • Faecal evacuations
    • Dysfunction
    • IBS
17
Q

What is the medical term for incontinence during sex?

A

Coital incontinence

18
Q

What investigations should be done for urinary incontinence?

A
  • 3 day urinary diary
    • Looks at fluid intake (quantity and quality), urine out-put, daytime frequency, nocturia, average voided volume
  • Urinalysis
  • Post voiding residual volume assessment (usually by bladder scanning)
  • Urodynamics
    • Only if indicated if surgical treatment is contemplated
19
Q

What does a urinary diary record?

A
  • Looks at fluid intake (quantity and quality), urine out-put, daytime frequency, nocturia, average voided volume
20
Q

What is the management of female urinary incontinence?

A
  • Stress urinary incontinence occurs when intra-abdominal pressure exceeds urethral pressure, causing leakage. So management is aimed at increasing urethral closure pressure
  • Lifestyle changes
    • Stop smoking, lose weight, healthy food, stop drinking alcohol and caffeine
    • Indications – everyone unless they do not wish it or previously failed
  • Physiotherapy
    • Pelvic floor muscle training
      • Effect – reinforcement of cortical awareness of muscle groups, hypertrophy of existing muscle fibres, general increase in muscle strength and tone
  • Pharmacological
    • Duloxetine
      • Indication – moderate to severe stress urinary incontinence, does not wish for surgery or previous failed surgery, patients family is not complete
  • Surgical
    • Colposuspension
    • Urethral/bladder neck closure
    • Suburethral sling
    • Tension free vaginal tape (TVT)
      • Advantages – less operative and postoperative morbidity than colposuspension
      • Complications – bladder perforation, vaginal and urethral erosion, vascular injuries
21
Q

What lifestyle changes can help with female urinary incontinence?

A
  • Stop smoking, lose weight, healthy food, stop drinking alcohol and caffeine
22
Q

What is the effect of pelvic floor muscle training?

A
  • Effect – reinforcement of cortical awareness of muscle groups, hypertrophy of existing muscle fibres, general increase in muscle strength and tone
23
Q

What drug can be used for female incontinence?

A
  • Duloxetine
  • Indication
    • In primary care: if muscle training has failed or would improve effect
    • Moderate to severe stress urinary incontinence, does not wish for surgery or previous failed surgery, patients family is not complete
24
Q

What surgery can be done for female incontinence?

A
  • Colposuspension
  • Urethral/bladder neck closure
  • Suburethral sling
  • Mid-urethral sling
    • Tension free vaginal tape (TVT) - FIRST CHOICE
      • Advantages – less operative and postoperative morbidity than colposuspension
      • Complications – bladder perforation, vaginal and urethral erosion, vascular injuries
    • Transobturator tape (TOT)
      • Advantages - cheaper (no need for cytoscopy), non evidence of bowel or major vascular injury
      • Disadvantages - moer diabling thigh pain, higher vaginal preforation and erosion rates
        *
25
Q

What are possible complications of female urinary incontinence?

A
  • Reduced quality of life
    • Reduce social relationships and activities
  • Mental health
    • Impair emotional and psychological well-being, sexual relationships, embarrassment
26
Q

What is overactive bladder syndrome?

A

A symptom complex usually, but not always, related to urodynamically demonstrable detrusor overactivity

27
Q

Describe the epidemiology of overactive bladder syndrome (age, sex)?

A
  • Prevalence increases with age, woman affected more than men until age exceeds 65 then men are affected more than woman
28
Q

What are risk factors for urge incontinence?

A
  • Advanced age
  • Diabetes
  • Urinary tract infections
  • Smoking
29
Q

What are the defining symptoms of overactive bladder syndrome?

A
  • Urgency (with/without urgency incontinence), usually with frequency and nocturia
  • Definitions of symptoms
    • Urgency – complaint of sudden, compelling desire to pass urine
    • Urge incontinence – complaint of involuntary leakage of urine accompanied or immediately preceded by urgency
    • Frequency – voids to often
    • Nocturia – wake during the night to void
30
Q

What is urgency?

A
  • Urgency – complaint of sudden, compelling desire to pass urine
31
Q

What is urge incontinence?

A
  • Urge incontinence – complaint of involuntary leakage of urine accompanied or immediately preceded by urgency
32
Q

What is frequency?

A
  • Frequency – voids to often
33
Q

What is nocturia?

A
  • Nocturia – wake during the night to void
34
Q

What is the management for overactive bladder syndrome?

A
  • Life style interventions
    • Normalise fluid intake, reduce caffeine, fizzy drinks, chocolate, stop smoking, weight loss
  • Bladder training programme
    • Timed voiding with gradually increasing intervals
  • Pharmacological
    • Antimuscarinic, could be
      • 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)
      • Kentera Patches
    • Tri-cyclic antidepressants
      • Imipramine
  • Recent advances on treatment
    • Botox
    • Neuromodulation
      • Needle stimulation
      • Effect – reflex inhibition to the detrusor muscle

Reproductive System (31 decks)

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