Session 7: Urinary Incontinence Flashcards
Classifications of lower urinary tract symptoms (LUTS)
Storage, voiding, post-micturition
LUTS of storage
Increased frequence, urgency, nocturia, incontinence
LUTS of voiding
Slow stream, splitting, spraying, intermittency, hesitancy, straining, terminal dribble.
LUTS of post-micturition
Post-micturition dribble, feeling of incomplete emptying.
Social problems with urinary incontinence.
Massive impact on quality of life, social exclusion, sense of shame.
Types of incontinence.
Stress urinary incontinence SUI
Urgency urinary incontinence UUI
Mixed urinary incontinence MUI
Overflow urinary incontinence OUI
Define SUI
Complaint of involuntary leakage on effort or exertion, or on sneezing, coughing etc..
Define UUI
The complaint of involuntary leakage of urine accompanied by or immediately proceeded by urgency. (Not making it to bathroom in time)
Define MUI
The complaint of involuntary leakage of urine associated with the urgency and also with extertion, effort, sneezing, coughing etc…
Define OUI
Involuntary micturition due to an overfull bladder
What is the most common form of incontinence?
SUI
Risk factors of UI
Pregnancy and childbirth, pelvic surgery, X-ray, pelvic prolapse.
Race, family predisposition, anatomical abnormalities, neurological abnormalities.
Menopause, drugs, UTI, obesity, age, chronic coughing.
Examination to determine UI.
BMI
Abdo exam to exclude a palpable bladder.
Digital rectal examination (male)
External genitalia stress test (Female)
Vaginal exam
Investigations of UI.
Urine dipstick for UTI, haematuria, proteinuria, glucosuria
Urodynamics like frequency-volume chart, bladder diary, post-micturition residual volume.
Pad tests
General conservative management of UI.
Modify fluid intake
Weight loss
Stop smoking
Decreased caffeine intake
Avoid constipation
Timed voiding
Other optional general treatments of UI.
Patients unsuitable for surgery but do not respond to conservative or medical treatment.
Urethral or suprapubic catheter.
Sheath device like a condom catheter.
Incontinence pads.
Initial management of SUI.
Pelvic floor muscle training for at least 3 months duration.
Pharmalogical management of SUI.
Duloxetine which is combined noradrenaline and serotonin. This increased the activity of the striated sphincter (EUS) during the filling phase to prevent incontinence.
Surgery for SUI in females.
Permanent intention (sling procedure).
Surgery for SUI in males.
Artificial urinary sphincter
Male sling procedure
Initial management of UUI.
Bladder training
Explain bladder training.
Schedule of voiding where you void every hour during the day. You must not void in between, you either wait or leak.
Intervals increased by 15-30 minutes a week until interval is around 2-3 hours.
This is done for at least 6 weeks duration.
Pharmagolocial management of UUI.
Anticholinergics acting on M3 receptors.
B3-adrenoceptor agonists.
Explain the effects of anticholinergics.
Antagonist of M3 to prevent involuntary contraction of the bladder
Side effects of anticholinergics as a treatment for UUI.
Can affect other organs.
There is such a thing as anticholinergic load where if you are on too much anticholinergics it can lead to cognitive damage.
Effects of B3-adrenoceptor agonists.
Causes more relaxation of bladder to increase the bladder’s capacity to store urine. Also increases tone of EUS.
Side effects of B3-adrenoceptor agonists.
In case of high BP this might not be favourable.
Can affect other organs.
Other pharmacological UUI treatments.
Intravesical injection of botulinum toxin. Inhibits the release of ACh at the pre-synaptic neuromuscular junction causing targeted flaccid paralysis.
Define enuresis in children.
Bedwetting. Involuntary wetting during sleep at least 2 times a week in children aged >5 years with no CNS defects.
Key questions of enuresis in children.
Age?
Primary (always bed wetted) or secondary (stopped bed wetting then and then started again)?
Daytime symptoms?
Pain passing urine?
Constipation?
Management of primary enuresis without daytime symptoms.
Managed in primary care with reasurrance, alarms with positive reward system and eventual desmopressin.
Management of primary enuresis with daytime symptoms.
Usually caused by disorders of lower urinary tract like anatomical or over-active bladder.
Referral to secondary care
Management of secondary enuresis.
Treat underlying cause like UTI, constipation, diabetes etc…
