Incontinence Flashcards
Definition
Any involuntary leakage of urine
Why does it arise?
Problems with the sphincter
Overactive detrusor muscle
Incontinence is more common in males. True or false?
False
- females
Risk factors
Woman Caucassian Neurological problems Anatomical variations Pelvic surgery Radiotherapy Diabetes Smoking - due to coughing Obesity UTI Increased fluid intake Previous childbirth
Clinical features
Voiding symptoms
- poor flow
- splitting or spraying of stream
- hesitancy
- straining
Examination
Painless palpable mass arising from pelvis
Cant get below it
Dull percussion
PR exam
Investigations
Urinalysis
Uroflometry
Pad test
Bladder diary (3 day)
What does uroflometry measure
How much urine you pass and how quickly
What should a bladder diary quantify
How many times you have went to the toilet
How much you have passed
Investigation if there are abnormalities in the bladder
Cystoscopy
Which investigation do you do to diagnose detrusor over-activity?
Urodynamics
Who gets urodynamics?
An patient with incontinence who is going for surgery
Name 4 types of incontinence
Urge incontinence
Stress incontinence
Mixed U+S incontinence
Overflow incontinence
What is nocturnal enuresis
Bed wetting at night
Urge incontinence - definition
Involuntary leakage of urine accompanied by or immediately preceded by urgency (sudden desire to void)
Urge incontinence - cause
Overactivity of the detrusor muscle
Urge incontinence - clinical frequency
Daytime frequency Small voided volumes Urgency Provoking symptoms - sound of running water - standing up
Urge incontinence - Management (lifestyle)
Avoid caffeine
Decrease fluid intake
Urge incontinence - management
Bladder retraining - holding in pee Antimuscarinics - work on M2 and M3 receptors to block detrusor contraction Beta 3 andrenergics Botox Surgery
Give 2 examples of anti-muscarinic medication used in urge incontinence?
Oxybutynin
Tolterodine
Give an example of bet 3 adrenergic medication for urge incontinence?
Mirabegron
Stress incontinence - definition
Invuluntary leakage of urine due to increased abdominal pressure
In stress incontinence the bladder is not strong enough - true or false?
True
Stress incontinence - causes
Damage to pelvic floor or urethral function
- childbirth
- coughing
- laughing
- sneezing
Stress incontinence - investigations
Urodynamics
Stress incontinence - lifestyle management
Decreased fluid intake
Stop smoking (cough)
Manage chronic cough
Weight loss
Stress incontinence - management
Pelvic floor exercises
- to invrease sphincter contractility
Serotonin (5-HT) and norepinephrine reuptake inhibitor (doluxetine)
Surgery - inject bulking agents
Overflow incontinence - definition
Build up of urine which eventually overflows
Overflow incontinence is due to a problem with the detrusor muscle. true or false?
True
Overflow incontinence - causes
Bladder outflow obstruction
Overflow incontinence - who gets it ?
Elderly patients
Overflow incontinence - clinical features
Bed wetting
Huge palpable bladder
Chronic retention
Overflow incontinence can be linked with renal impairment - true or false?
True
- pressure inside the bladder is too high and there is reflux back into the kidneys (hydronephrosis)
Overflow incontinence - investigations
Assess renal function
- look for signs of hydronephrosis
Overflow incontinence - management
Treat obstruction
Catheterise patient
Name 2 types of incontinence associated with extra-urethral route
Ectopic ureter
Fistula
Ectopic ureter usually occurs with a duplex kidney. True or false?
True
Ectopic ureter is congenital/acquired?
Congenital
Ectopic ureter - clinical features
Antenatal hydronephrosis
Fistula - cause
Prolonged obstructed labour
