INCONTINENCE Flashcards
What proportion of women under the age of 65 are affected by a degree of urinary incontinence?
8.5%
What proportion of women over the age of 65 are affected by a degree of urinary incontinence?
11.6%
What proportion of women over the age of 85 are affected by a degree of urinary incontinence?
43.2%
What are the 5 main types of urinary incontinence?
Stress incontinence - also called effort incontinence
Urge incontinence - also called detrusor overactivity
(Mixed incontinence)
Overflow incontinence
Functional incontinence
Total incontinence
What is the aetiology of stress urinary incontinence?
Insufficient strength of the pelvic floor muscles to prevent the passage of urine, especially during activities that increase intra-abdominal pressure, such as coughing, sneezing, or bearing down.
What are the risk factors for developing stress urinary incontinence?
Increasing age Increasing parity Obesity Genital prolapse Postmenopausal state Previous pelvic floor surgery Constipation Smoking / chronic cough
What are the classic features of stress urinary incontinence?
Small amounts of leakage
Associated with coughing, sneezing, laughing or running
Frequency of micturition
What is the aetiology of urge incontinence?
Involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate. It is normally caused by the detrusor muscles of the bladder being overactive.
What are the risk factors for developing urge urinary incontinence?
Increasing age History of nocturnal enuresis Neurological disorders Previous incontinence surgery - leading to nerve damage Alcohol or coffee Poor fluid intake - leading to concentrated urine which can irritate detrusor Spinal tumours UTI
What are the classic features of urge urinary incontinence?
Urgency
Frequency
Nocturia
What is mixed urinary incontinence?
This is a commonly seen picture where the patient suffers from both stress and urge (detrusor overactivity) incontinence. The history will show elements of both leakage on abdominal pressure and urgency of micturition.
What is the aetiology of overflow incontinence?
The bladder will fill up as usual, but as it is obstructed the patient will not be able to empty it completely. At the same time, pressure from the urine that is still in the bladder builds up behind the obstruction, causing frequent small leaks.
What are the risk factors for overflow urinary incontinence?
BPH
Bladder stone
Constipation
Weak detrusor muscles
What are the classic features of overflow incontinence?
Urgency Frequency Hesitancy Straining to void Poor flow Recurrent UTI
What is the aetiology of functional incontinence?
This is not a pathology of the bladder. It occurs when the person recognizes the need to urinate but cannot make it to the bathroom for reasons not associated with their urinary system.
What are the risk factors for functional urinary incontinence?
Confusion / delirium Dementia Poor eyesight Poor mobility - Parkinson's disease Depression Anxiety Inebriation due to alcohol Peripheral autonomic neuropathies - diabetes
What is the aetiology of total incontinence?
Total incontinence occurs when your bladder does not store any urine at all. It can result in you either passing large amounts of urine constantly, or passing urine occasionally with frequent leaking.
What are the causes of total incontinence?
Birth bladder defect
Injury to spinal cord - eg surgery
Bladder fistulae - Obstructed labour is common cause
What investigations might you do for someone that was experiencing incontinence where the aetiology was unclear?
Urine dip to exclude UTI
Complete a bladder diary
Urodynamic studies:
Uroflowmetry - identify voiding disorders
Cystometry - will confirm or exclude detrusor overactivity
Videocystourethrography
Cystoscopy - excludes polyps, calculi and malignancy (rarer causes of incontinence)
Ultrasound - pelvic masses
Radiological investigations - identifying fistulae
What are the conservative management options for treating stress urinary incontinence?
Weight loss
Reduction in caffeine intake
Quit smoking - to treat chronic cough
Physiotherapy - pelvic floor exercises or insertion of vaginal cones
What are the medical management options for treating stress urinary incontinence?
Oestrogen replacement can improve symptoms in postmenopausal women, however long term use is required to maintain this effect.
Duloxetine (serotonin noradrenaline reuptake inhibitor, SNRI) - increases the tone of urethral sphincter. Most useful when used in conjunction with pelvic floor exercises.
What are the surgical management options for treating stress urinary incontinence in women?
Insertion of a tension free vaginal tape through a small vaginal incision over the mid-urethra.
How is urge (or detrusor overactivity) urinary incontinence treated?
Primarily through antimuscarinic medications such as: Oxybutynin Tolterodine Solifenacin Trospium
Also, Mirabegron which activates beta-3 adrenergic receptors is used to treat detrusor overactivity
What are the main side effects of antimuscarinic medications used in the treatment of urge incontinence?
Think about what atropine does:
Dry mouth Reduced visual accommodation Constipation Glaucoma Confusion
