Incontinence Flashcards
Incontinence definition
Inappropriate involuntary voiding of urine causes hygienic and social problems
Name the types of incontinence
Stress incontinence Urge incontinence Overflow incontinence Total urinary incontinence
Stress incontinence
Leakage of urine form the urethra with an increase in intraabdominal pressure in absence of a derisory contraction
Urge incontinence
Inability to suppress reflex bladder contractions
Total urinary incontinence
Continuous dribbling with low residual volume
Filling and storage of urine needs?
Compliance Closed outlet Sensation of filling appropriately No involuntary derisory contraction
The appropriate and voluntary voiding of urine requires
Cordinated detrusor contraction
Simultanous opening/relaxation of bladder outlet
No obstruction of bladder outlet
Mechanisms to curb stress incontinence in women
Increased abdominal pressure is transmitted to the urethra and bladder
Types of stress incontinence in women
Intrinsic urethral sphincter defiency
Urethra hypermobility
Classification of urinary incontinece by causes
Failure to store
Failure to empty
Abnormal opening
Urethral diverticulum
Bladder factors in failure to store incontinence
Involuntary contractions
detrusor instability
detrusor hyperreflexia
Urethral factors in failure to store causes of incontinence
Anatomical stress incontinence (females)(urethral)
Post surgery (post prostectomy and post female incontinence surgery
After radiotherapy fr cervical therapy
After infiltration of external sphincter in BPH
Atrophic vaginitis
Neurological (sacral lesions and meningomyelocoele)
Bladder factor s in failure to empty incontinence cause
Neurogenic LMN neuropathic bladder
Myogenic atonic detrusor
Drugs trycyclic antidepressants
Urethral factors in failure to empty incontincence
Anatomic obstruction
- stricture
- bladder neck stenosis
- prostatic obstruction
Functional obstruction
- UMN neuropathic bladders where there is detrusor sphincter dysgernia contraction against closed external sphincter
Abnormal openings in incontinence causes
Vesicovaginal fistula
Uretovaginal
Urththrovaginal
Ectopic ureter opening into vagiinaa for e.g
Asepcts of detail of incontinence in history
Type
Precipitating factors
Severity
Bladder diary
Past medical Hx
Neuro
Surgery
Parity
Drugs
Causes of transient incontinence
DIAPPERS
delirium
infection
atrophic vaginitis
pharmaceuticals(diuretics)
psychological (depression)
excessive urine output( D)
Restricted mobility
Stool impaction
Management of bladder factors
Medical
- anticholinergic drugs oxybutynin-ditropan, tolterodine-detrusitol
Surgical
- augmentation cystoplasty
Management of urethral fx.
Increase bladder outlet resistance
medical
- alpha adrenergic agonists
Increase urethral resistance in females
Medical
- pelvic floor exercise and HRT
Surgical
- Tension free vaginal tape
- periurethal injection
- artificial urinary sphincter
Bypass urethra urinary diversion
Management of bladder fx in failure to empty
Clean intermittent self catheterisation
Mx of urthral fx. in failure to empty
Management of abnormal openings
Surgical closure
Ureter implantation
Excision
