Module 4.3 (Urinary Incontinence) Flashcards
Define the following terms:
A) Urinary incontience/enuresis
B) Nocturnal enuresis
C) Urgency
D) Nocturia
E) Increased daytime frequency
F) Retention
A)
- The complaint of any involuntary leakage of urine
B)
- Any involuntary loss of urine during sleep
C)
- The complaint of a sudden, compelling desire to pass urine, which is difficult to defer
- Urgency can be with/without incontinence
D)
- The complaint that the individual has to wake at night one or more times ot void
E)
- The complaint by the patient who considers that he/she voids too often by day
F)
- Inability to urinate
What is meant by continene?
A normal bladder
- empties 4-8 times each day (every 3-4 hours)
- can hold up to 400-600ml of urine (the sensation of needing to empty occurs at 200-300 ml)
- may cause nocturnal awakening once at night to pass urine (twice if over 65 years of age)
- Tells a person when it is full but gives them enough time to find a toilet
- Empties completely each time urine is passed
- Does not leak urine
What does untreated UI heighten the risk of?
- Infection
- Pressure ulcers –> skin infections
- Social isolation and depression
- Loss of sleep
- De-conditioning
- Falls and associated fractures
- Nursing home admission
What is the physiology the bladder?
When want to fill ballder = cholinergic nerves turned off and beta adrenergic system turned on. If beta adrenergic system turned on = sphincter will constrict.
When want to urinate = cholinergic nerves turned on and beta adrenergic system turned off. Cholinergic nerves turned = detrusor contracting and push urine out of the bladder and into the urethra.
What are the basic requirements for continence?
Bladder – relaxed while filling, contracts to empty ◼
Sphincter mechanism – prevents leakage and relaxes to urinate ◼
Pelvic floor – supports the bladder and aids the sphincter ◼
Nervous system – transmits messages to/from brain ◼
Brain – interprets messages and sends commands ◼
Locomotor ability – to get to and use the toilet
What does urine storage require?
Accommodation of increasing volumes of urine at a low intravesical pressure (normal compliance) and with appropriate sensation.
A bladder outlet that is closed at rest and remains so during increases in intra- abdominal pressure.
Absence of involuntary bladder contractions (detrusor overactivity).
Bladder emptying/voiding requires?
A coordinated contraction of the bladder smooth musculature of adequate magnitude and duration.
A concomitant lowering of resistance at the level of the smooth and striated sphincter.
Absence of anatomic (as opposed to functional) obstruction.
What are some risk factors for urinary incontinence?
Women
- Pregnancy
- Child birth
- Menopause
- Pelvic Surgery
Men
- Benign prostatic hyperplasia
- Prostate surgery
Non gender-specific
- Smoking
- Obseity
- Recurrent urinary tract infections
- Reduced mobility
What the medical conditions asscociated with UI?
◼ Stroke ◼ Parkinson’s disease ◼ Dementia◼ Sleep apnoea ◼ Depression ◼ Behavioural disorders ◼ Diabetes (polyuria, polydipsia, neuropathy) ◼ Congestive heart failure
CHF: produce more urine at night time because renal perfusion is better at this time = increased risk of nocturnal enuresis
What are the types of UI?
Stress urinary incontinence
- Involuntary leakage on effort, exertion, sneezing or coughing
Urge urinary incontinence
- Involuntary leakage immediately preceded by urgency
Overflow urinary incontinence
- Also referred to as “chronic retention of urine”
- Emptying failure by outlet obstruction or inability to contract detrusor
Functional incontinence
- Lack of recognition or ability to get to toilet in time - unrelated to bladder and nervous control
Mixed incontinence
- Combinations of the above
General management principles for UI?
- Decrease intake of fluids, caffeine, and carbonated drinks
- Constipation should be managed and avoided
- Lose weight if BMI >25kg/m2
- Urodynamic studies
- UTI investigations
- Bladder diary
> Number of pads needed over 24 hrs and their type
> Activity restriction
> Frequency of accidents
> Record of symptoms – presence, frequency, severity
The most common type of incontinence amongst young and middle-aged women? Caused by?
Stress Incontinence
Caused by:
- Childbirth, pelvic surgery (eg prostatectomy), or an abnormal position of the urethra or uterus
- Lack of oestrogen in postmenopausal women
- Obesity
What medications to cease for stress incontinence?
alpha-adrenergic blockers becuse it relaxes the sphincter
systemic oestrogen
What to use for stress incontinence?
Topical oestrogens = thicken up mucus membranes and strengthen sphincter
Duloxetine (5HT and NA) –> 5HT and NA causes sphincter to constrict
A-adrenergic agonists = not used much
How to manage stress incontinence?
Pelvic floor exercises ◼ Treat chronic cough ◼ Treat constipation/ faecal impaction ◼ Weight reduction ◼ Surgery ◼ Vaginal pessaries (nonmedicated)
