Incontinence Flashcards
What is stress incontinence
Leaking of urine on effort or exertion - e.g. sneezing
Common in women
What is urge urinary incontinence
Leakage accompanied by or immediately preceded by urgency.
What causes urge urinary incontinence
Bladder overactivity - detrusor instability
Can be due to pathology that irritates the bladder
What causes stress incontinence
Caused by bladder neck/urethral hypermobility and/or neuromuscular defects leading to sphincter deficiency
Weak pelvic floor
What is mixed urinary incontinence
Combination of stress and urge incontinence
What does bed wetting indicate
High-pressure chronic urinary retention
Common in elderly men
What causes post-micturition dribbling
This occurs in men immediately after leaving the toilet
Caused by urine pooling in the bulbar urethra
What is overflow incontinence
Seen in those with chronic retention
Urine is release unintentionally as bladder cannot hold it
What does a continuous flow of urine suggest
Fistula between the urethra and vagina or an ectopic ureter (seen in young girls
Is incontinence more common in women or men
Women
List risk factors for incontinence
Genetic predisposition Neurological disorder - stroke, cord injury Anatomical abnormality - fistula, diverticulum etc Childbirth Pelvic, perineal and prostate surgery Radiotherapy Diabetes Smoking - coughing UTI Oestrogen deficiency Cognitive defect Increased fluids
What are the red flag urinary symptoms
Pain Haematuria Recurrent UTI Voiding/obstructive symptoms Mass Neurological deficit History of pelvic surgery/radiotherapy
List some investigations for incontinence
Keep a bladder diary Urinalysis and culture Flow rate and post-void residue Pad testing Blood tests Scans
Give examples of conservative treatments for incontinence
Pelvic floor exercise - good for stress
Lifestyle - weight loss, smoking, modify fluid intake, reduce alcohol and coffee
Bladder training
Which medications are available for treating incontinence
Duloxetine - increases sphincter muscle activity by inhibiting reuptake of adrenaline and serotonin
Which surgical treatments are available for incontinence
Injections of bulking agents into the bladder neck to improve sphincter seal
Retropubic suspension
Sub urethral tapes and sling - supports the bladder more
Artificial urinary sphincter
Describe retropubic suspension
Elevate and fix the bladder in a retropubic position so that the neck is better supported
How do artificial urinary sphincters work
Inflatable cuff is placed around bulbar urethra or bladder neck
A pressure regulating balloon is placed in the abdomen
An activating pump is put in the scrotum or labia majora
Pump is squeezed which transfers fluid to the balloon and the cuff deflates allowing voiding
What conservative treatments are available for overactive bladders
Pelvic floor exercise Biofeedback Acupuncture Electrical stimulation therapy Modify fluid intake, avoid caffeine and alcohol Bladder training
which medication can be used for an overactive bladder
Anticholinergics - inhibit contractions and increase bladder capacity
E.g. oxybutynin
B3 adrenoreceptor agonists - mirabegron
How can botox be used in incontinence
In overactive bladders you can inject under the mucosa or into the detrusor
Abolishes unstable contraction by partially paralysing the detrusor
Repeated 3-4 times a year
What is neuromodulation
Use a device to stimulate the sacral nerves (S3) which inhibits detrusor activity
Test percutaneously first and if successful a device can be implanted
What is a ‘clam’ ileocystoplasty
Operation where the bladder is opened and a section of ileum is attached to create a larger bladder volume
Used in urge incontinence and intractable frequency
what is a ileal conduit urinary diversion
Ureters are anastomosed and connected to a small length of ileum which is brought out in a stoma
For intractable cases only
