Incontinence Flashcards
What is stress urinary incontinence?
leakage on effort or exertion
when abdo pressure > urethral resistance
What causes stress urinary incontinence?
bladder neck/urethral hypermobility
neuromuscular defects causing intrinsic spinchter deficiency
What is urge urinary incontinence?
leakage accompanied or immediately preceeded by urgency
What causes urge urinary incontinence?
bladder overactivity - detrouser instability
infection, tumour or stone irritating the bladder
What does high pressure chronic retention cause?
bedwetting in older men
What does a post micurition dribble indicate?
urine pooling in the bulbar urethra
What does a constant leak suggest?
fistula between the bladder and the vagina due to surgery injury
or presence of eptopic ureter draining into the vagina if presents in a young girl
What are the risk factors for urinary incontinence?
female > male caucasian > afrocarribean neurological disorders child birth pelvic, perineal and prostate surgery diabetes radical pelvic radiotherapy oestrogen deficiency
What red flags should you look out for?
pain haematuria recurrent UTI history of pelvic surgery/radiotherapy significant voiding/obstructive symptoms
What investigations can be done for bladder incontinence?
bladder diary urinalysis + culture flow rate and post void residue pad testing cystoscopy - endoscopy of the bladder cytometry - two way catheter into the bladder
What are the conservative treatments for incontinence?
pelvic flood exercises
weight loss
stop smoking
modify fluid intake
duloxeine - inhibits the reuptake of serotonin and noradrenaline - increasing spinchter muscle activity
electrical stimulation of the pelvic floor
What are the surgical options for incontinence?
injection of bulking materials into the bladder neck and periurethral muscles to increase outlet resistance (female stress)
retropubic suspension (also done for female stress)
artificial urinary spinchter - pump squeezed to void
intravescle botox
neuromodulation - electrical stimulation of the nerve supply of bladder
clam ileocytoplasty
ileal urinary diversion
What are the symptoms of an over reactive bladder?
urgency with or without urge incontinence
usually increased frequency and nocturia
due to detrouser over activity
What are the treatments of over reactive bladder?
reduce caffine and alcohol pelvic floor excercises biofeedback accupuncture electrical stimulation
What is the role of acetylchloine in the bladder?
acts on smooth muscle receptors to cause involuntary contractions and provoke over activity
