Lecture 12-Urinary Incontinence Flashcards
How can a lower motor neurone lesion cause incontinence?
Low detrusor pressure -> large residual volume -> incontinence
How does an upper motor neurone lesion present?
- bladder has to work hard against sphincter that is closed when it shouldn’t be (dilated ureters and thick detrusor)
- high pressure detrusor contractions
- poor coordination with sphincters
- backflow of urine into ureters
What are the 3 types of urinary incontinence?
- SUI = stress urinary incontinence
- UUI = urge urinary incontinence
- MUI = mixed urinary incontinence
What is SUI?
Incontinence on effort or on sneezing/coughing
What is UUI?
Leakage with urgency
What is MUI?
Leakage, urgency and also with effort, exertion, sneezing or coughing
What are the risk factors of urinary incontinence?
Pelvic surgery, pregnancy, race, family history, menopause, drugs, UTI, age, obesity
What are the lifestyle interventions to manage incontinence?
Fluid, weight loss, stop smoking, reduce caffeine, timed voiding
What are the management options for patients unsuitable for surgery who have failed conservative management?
- indwelling catheter
- sheath device
- incontinence pads
What are the management options for patients with SUI?
- initial: pelvic floor muscle training
- drugs: duloxetine
- surgery in females: vaginal tapes, slings, bulking agents
- surgery in males: artificial urinary sphincter, retropubic suspension, sling to support urethra, bulking agents, artificial IUS
What are the management options for patients with UUI?
- initially, bladder training by scheduling voiding
- drugs: anticholinergics which act on M2 and M3. Beta-3 agonist to increase bladder’s capacity to store urine. Botulinum injection to inhibit ACh release
- surgery: urinary diversion, autoaugmentation
