Incontinence Flashcards
1
Q
What is Urinary Incontinence?
A
- Involuntary leakage of urine
2
Q
What are the sub-types of Urinary Incontinence?
A
- Stress Incontinence
- Urgency Incontinence
- Mixed Incontinence
- Overflow Incontinence
3
Q
What is Stress Incontinence?
A
- Involuntary leakage of urine related to increased intra-abdominal pressure
- Such as coughing, sneezing or exertion
4
Q
What are the some of the Risk factors for Stress Incontinence?
A
- Factors that lead to a weakening of the pelvic floor muscles
- Age
- Pregnancy & Vaginal deliver
- Constipation
- Obesity
- Family History
5
Q
How would you investigate Incontinence?
A
- History Taking and Physical Examination
- Assessing Pelvic Floor Muscles
- Urine Testing = Urine Dipstick, if positive = MSU
- Bladder Scan - Assessing Residual Urine = Measuring post-void residual volume
- Bladder diaries = minimum of 3 days of the diary on working and leisure days
- Urodynamic testing = Multichannel filling (a catheter is inserted into the bladder and rectum to measure pressures as the bladder is slowly filled with water) and voiding cystometry ( a catheter is inserted into the urethra until it reaches your bladder, it allows measurement of the amount of urine remaining in the bladder plus it measures the strength of the bladder)
6
Q
What is the management for stress incontinence?
A
- Lifestyle:
1. Consistent fluid intake around 1.5-2 litres avoiding either excess or insufficient amounts
2. Healthy weight loss
3. Smoking cessation services
4. Avoid caffeine - Pelvic Floor Muscle Training: A trial of at least 8 contractions performed 3 times per day for a minimum of 3 months to strengthen the pelvic floor
- Pharmacological Techniques: Duloxetine (SNRI - increased stimulation of urethral striated muscles within the sphincter), side effects: dry mouth, headache, dizziness, nausea, sexual dysfunction and increased suicide risk)
- Specialist Care Training:
1. Colposuspension (operation which involves lifting the bladder neck upwards with stitches placed to hold it in place)
2. Autologous Rectus Fascial Sling (a sling is made from the patient’s own fascia and is used to support the urethra and the pelvic floor muscles)
3. Retropubic mid-urethral tape procedures
7
Q
What is Urge Incontinence?
A
- The urge to pass urine associated with involuntary leakage
- It occurs secondary to an overactive bladder
- due to detrusor muscle overactivity that leads to involuntary contractions of the bladder
- Typically idiopathic but can occur secondary to neurological disorders
8
Q
What is the managment of Urge Incontinence?
A
- Lifestyle: Consistent fluid intake (1.5-2 litres), reduced caffeine, supportive weight loss methods
- Bladder training - trial of 6 weeks, training the bladder to tolerate larger volumes of urine instead of going to pass urine as soon as you feel the need to go - the patient is advised to hold it for gradually longer lengths of time
- Pharmacological therapy - Anticholinergic therapy, used in patients with an overactive bladder as they help to reduce detrusor activity. First line = Oxybutynin
9
Q
What is Overflow Incontinence?
A
- Overflow incontinence happens when someone is unable to completely empty their bladder
- Normally a complication of chronic urinary retention, whereby the progressive stretching of the bladder wall leads to damage to the efferent fibres of the sacral reflex and loss of bladder sensation
- The bladder fills and becomes grossly distended leading to intravesicular pressure building - leading to a constant dribble of urine
- most common cause = prostatic hyperplasia, however spinal cord injury and congenital defects may be a cause
- It can occur secondary to physical obstruction or under activity of the detector muscle
1. Bladder Outlet Obstruction: refers to physical blockage and compression of the urethra due to prolapse, fibroids or following pelvic surgery
2. Detrusor Under-activity: reduced or impaired contraction of the detrusor muscle can lead to retention and overflow leakage. Occurs in advancing age, impaired peripheral neuropathy, spinal cord pathologies and secondary to medications (antimuscarinics)
10
Q
What is the treatment for Overflow Incontinence?
A
- referred to urology/ gynaecology
- Catheterisation to be considered -when pathology can not be corrected and is leading to UTIs
11
Q
What is Functional Incontinence?
A
- Co-morbid physical conditions impair the patient’s ability to get to a bathroom in time
- Causes: dementia, sedating medication, injury/illness causing decreased ambulation
12
Q
What is Oxybutynin?
A
- Anti-muscarinic drug
- Used for Urge Incontinence
- Side Effects: dry mouth, headache, vertigo, vomiting, constipation, wind, stomach pain and dry eyes
13
Q
What is Solifenacin?
A
- Anti-muscarinic drug
- Used for Urge Incontinence
- Side effects: dry mouth, headache, vertigo, vomiting, constipation, wind, stomach pain and dry eyes
14
Q
What is Mirabegon?
A
- Beta-3-adrenergic-receptor agonist
- Used for Urge Incontinence
- Side effects: Arrhythmias, constipation, diarrhoea, dizziness, headache, increased risk of infection and nausea
15
Q
What is Trospium?
A
- Anti-muscarinic drug
- Used for Urge Incontinence
- Side effects: constipation, dizziness, drowsiness, dry mouth, headache, nausea, palpitations, tachycardia, urinary disorders, vision disorders and vomiting
