Incontinence Flashcards
What are the 6 main types of incontience
Stress -> incontinence due to an increased intra-abdominal pressure
Urge -> sudden urge to pass urine due to overactivity of the detrussor muscle
Overflow -> urine retention due to an incompatipility for complete voiding
Neurogenic -> incontinence due to a decreased nerve sensitivity controlling urination
Post-coital -> incontinence after penetration or orgasm
Mixed -> just a wee mix of all types of incontinence
What treatment should always be done for incontinence
Pelvic floor fucking exercises
What type of incontinence is duloxetine used to treat
Stress
What type of incontience is Trans-cutaneous Electrical Nerve Stimulation (TENS) used to treat
Overflow
What type of incontinence is neuromodulation used to treat
Neurogenic
What type of incontinence can be caused by prolonged catheterisation and therfore treated by removing said cathater
Neurogenic
Why can coughing, sneezing and moving cause stress incontinence
As they all cause an increased intra-abdominal pressure
What type of drug is duloxetine
Serotonin and Norepinephrine Reuptake Inhibitor (SNRI)
Women who have had several pregnancies are at an increased risk of what type of incontinence
Stress incontinence
Which type of incontinence have patients that ‘know where every public toliet is’
Urge
What type of incontinence is due to involuntary contractions of the detrussor muscle
Urge
What type of incontinence can also cause urine retention and why
Overflow
The urethra is blocked so you can’t fully voi
What type of incontinence can be caused by benign prostate hyperplasia (BPH) and how can it be treated
Type of incontince -> overflow
Treated with -> Trans urethral resection of the porstate (TURP) & a-blockers
What are some of the causes of neurogenic incontinence
Prolonged cathertisation
Neurological disease (e.g. stroke or MS)
What is a way of indicating the severity of incontinence
How many pads the woman gets through
Urine incontinence can occur during the night, what is the definition of nocturia
Waking up on more than 1 occasion to piss
What type of incontience can cause recurrent UTIs and why
Overflow incontinence
Due to urine retention
What is the 1st line investigation that you should get all patients who complaining of incontience to kick-off with
3-day urine diary
What investigation shoudl you do if haematuria occurs
Cystoscopy
What are the investigations for incontinence
3-day urine diary
Abdominal & pevlic exam
Urinalysis
Mid-stream sample of urine (MSSU)
Cystosocpy
Urodynamics
What are some of the risk factors for incontinence
Being a woman
High parity
Heavy baby
Induced pregnancy
Old age
Obesity
Pelvic floor trauma
Smoking
Environment
What environment can increase your risk of incontinence
Being in hopsital
If a patient with incontience is obese and has a BMI of over 35, what treatments can you not undergo
Surgery
What methods of induced labour increases your risk of incontinve
Forceps delivery
Vaccuum extraction
What sex is most likely to suffer from incontience
Females bruh
What is the 1st line treatment for incontinence and for how long should they be used for
Pelvic floor exercises
Used for 3 months
What are some of the causes of incontinence
Stressful lifestyle
Pelvic trauma
Detrussor degeneration (old age)
Diuretics
Drinking too much
BPH
Defect in vesico-ureteric valve
What medication shoudl you always check that patients with incontinence are on as they may be the cause of it
Diuretics
What is a very common reason for incontinence that should be discussed with the patient
Drinking too much
In a history, what should you discuss with patients with incontinence
Age
Parity
Mode of deliverly (e.g. foreceps)
Weight of heaviest baby
Smoking history
HRT
PMH
What questions should you ask in a patient’s PMH about incontinence
Diabetes (can cause a big baby that damages the pelvic floor)
Cardio/liver/renal problems
Hypertension
Glaucoma
Why must you ask if patient’s with incontinence have/had glaucoma
As they wont be able to be treated with anti-cholinergics
What are the treatments for incontinence
Lifestyle changes
Pelvic floor exercises
Vaginal cones
a-/B-adrenoreceptor agonists
Anti-cholinergics
Anti-musacrinics
Surgery
How do anti-cholinegrics treat incontinence
Blocks the action of ACh
Decreases sympathetics tone
Increases parasympathetic tone
Which drugs treat incontince by increasing sympathetic tone
a-adrenorectpor agonsits
B-adrenoreceptor agonists
Anti-muscarinicns
When would you use B-adrenoreceptor agonists to treat incontinence
When anti-muscarinics can’t be used
What surgical treatments are used for incontinence
Burch Colposuspension
Cathaterisation
Trans-vaginal tape
What is the name of the CNS centre that controls urination
Pontine micturation centre
What 2 nerves control the parasymapthetic innervation for urination
Pelvic nerve
Pudendal nerve
What spinal nerves provide parasympathetic innervatoin for urination
S2-S4
What 2 type of nerves provide sympathetic innervation for urination and what spinal levels are the following nerve
B-adrenoreceptors -> T10-L2
a-adrenoreceptors -> T10-S2
What nervous system controls the external urethral sphincter and therefore provides voluntary control over urination
Somatic nervous system
What are the 3 requirements for urination to occur
Involuntary relaxatoin of internal urethral sphincter
Involuntary contraction of bladder
Voluntary relaxation of external urethral sphincter
What is the normal bladder capcaity
400-600ml
After what volume of urine in the bladder causes you to:
a) feel like you need to pee
b) desperate to pee
a) 250ml
b) 500ml
