Incontinence Flashcards
Outline the possible storage symptoms of urinary incontinence
Frequency
Urgency
Nocturia
Incontinence
Outline the possible voiding symptoms of urinary incontinence
Slow stream
Spitting/spraying
Intermittency
Hesitancy
Straining
Terminal dribble
Outline the possible post-micturition symptoms of urinary incontinence
Post-micturition dribble
Feeling of incomplete emptying
Outline overflow incontinence
Involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate
Neural lesion = between S2-S4
Outline the predisposing risk factors relating to urinary incontinence
Co-morbidities
Obesity
Age
Increased intra-abdo pressure
UTI
Drugs
Menopause
Briefly outline the investigations used to aid diagnosis of urinary incontinence
Urine dipstick/MSU = UTI, haematuria, proteinuria, glucosuria
Frequency-volume chart
Bladder diary
Post-void bladder scan – in pts with voiding dysfunction
Pressure-flow studies +/- video
Pad tests
Cystoscopy
What lifestyle modifications can help address urinary incontinence?
Modify fluid intake
Weight loss
Stop smoking
Decrease caffeine intake
Avoid constipation
Timed voiding
Outline treatment options for pts unsuitable for surgery and who have failed conservative management
Indwelling catheter = indwelling, suprapubic
Sheath device = adhesive condom attached to catheter tubing and bag
Incontinence pads
What is the initial management for stress urinary incontinence?
Pelvic floor muscle training
What are the male and female surgery options for stress urinary incontinence?
Females = low tension vaginal tapes, intramural bulking agents
Males = artificial urinary sphincter, male sling procedure
How is urge urinary incontinence initially managed?
Bladder training = schedule of voiding
What is the pharmacological management for urge urinary incontinence?
1st Anticholinergics = act on muscarinic receptors M2 and M3 (oxybutynin, tolteridone)
2nd Beta-3 adrenoceptor agonist = increases bladders capacity to store urine (mirabegron)
Vaginal oestrogen = vaginal atrophy
What are the surgical options when treating urge urinary incontinence?
Sacral N neuromodulation
Autoaugmentation
Urinary diversion
What questions are important during an incontinence Hx?
- storage symptoms
- voiding symptoms
- pain, dysuria, haematuria
- childhood symptoms
- bowel function/frequency
- PMH
- surgery
- Obs+Gynae Hx
- Med review
What factors are important during an incontinence exam?
CVS = signs of chronic disease
Cognition = AMT
Neuro = gait, dorsiflexion of toes (S3), perineal sensation (L1-L2), sensation of the sole (S1), sensation of posterior thigh (S3)
Abdo = masses, enlarged kidneys, distended bladder
DRE = anal tone, constipation, rectal mass, prostate
Pelvis = vaginal atrophy, prolapse
What are the reversible causes/contributing factors to urinary incontinence?
Fluid intake UTI Function - poor mobility, visual impairment, poor dexterity, risk of falls Medication Smoking Atrophic vaginitis DM Chronic constipation
What medications/drugs can potentially worsen UI?
Diuretics, anti-cholinergic, caffeine, alcohol, beta-blockers/CCB (relax sphincters)
What are the similarities and differences between men and women regarding UI?
Women – urge more common, obstetric Hx
Men – prostate
What is the most common cause of UI in the elderly?
Infection
What medication should not be prescribed in the elderly for urinary incontinence, what can be prescribed instead?
OXYBUTANIN
- urinary retention, falls, confusion
Instead = MIRABEGRON
When a patient is presenting with urgency, dysuria, burning what Dx should you be thinking of?
Atrophic vaginitis
Pale vaginal wall = lack of oestrogen = low flora = inflam
Mx = vegifet (topical oestrogen)
What key areas should be explored in a continence assessment?
Detailed continence Hx
Review bladder/bowel diary
Abdo exam
Urine dipstick / MSU
PR exam including prostate exam in males
External genitalia review (atrophic vaginitis in females)
Post micturition bladder scan
What key areas need to be addressed when managing incontinence?
Switch to decaffeinated drinks
Good bowel habit
Improving oral intake
Regular toileting
Pelvic floor exercises and bladder retraining
Oxybutanin (younger pt not older)
MIRABEGRON - older pts
