Incontinence: Flashcards
Give 4 risk factors for incontinence:
- Multiparity
- Hysterectomy
- Obesity
- Menopause
Give the 4 types of incontinence:
- Stress
- Urge
- Overflow
- Functional
Outline the normal /storage voiding control:
Storage:
- Detrusor muscle progressively relaxes as the bladder fills (static pressure)
- Sphincter muscle tone increases
- Sympathetic control
Voiding:
- Sphincter muscle relaxes & detrusor muscle contracts
- Parasympathetic (pelvic splanchnic nerves)
Give 3 treatments for stress incontinence:
- Pelvic floor exercises
- Lifestyle (avoid caffeine)
- Duloxetine (SNRI)
- Surgery (TFT), colposuspension
What do urodynamic studies show in urge incontinence?
^ detrusor activity
Give 3 treatments for urge incontinence:
- Limit fluid intake
- Bladder drill -> 4hrly voiding
- Botox injections
- Mirabegron (Beta3- adrenergic agonist -> relaxes detrusor muscle
Surgery - bladder augmentation
What features are seen in overflow incontinence?
- Constant dribble/dribble after voiding
- Very high residual volume (>300ml)
What can cause overflow incontinence?
Obstruction - urethral strictures (BPH, renal stones, bladder stones)
Detrusor under-activity
What is the treatment for BPH which can help solve overflow incontinence?
Doxazosin (Alpha-blocker)
Give 2 management options for overflow incontinence:
- Intermittent self catheterisation
- Pads
What investigations can be performed in incontinence?
- Voiding diary
- Physical examination
- Perianal sensation?
- Urine dipstick = r/o UTI
- Bladder scan post voiding
- Urodynamics
What graph is produced during urodynamics?
Cytometrogram:
- PAbdo
- Pdetrusor
- Pbladder
Catheter placed in bladder and fills with saline (usually warmed)
