Sexual Health - Urinary Incontinence Flashcards
What is urge incontinence?
Overactivity of the detrusor muscle
- Suddenly feeling the urge to pass urine
- Having to rush to the bathroom and not arriving before urination
Why can urge incontinence have such a big impact on QoL?
Very conscious about having bathroom access
May avoid activities or places where they may not have easy access
What is stress incontinence?
Due to weakness of the pelvic floor and sphincter muscles
Allows urine to leak at times of increased pressure on the bladder
What is mixed incontinence?
Combination of both
Crucial to identify which is having the more significant impact
What is overflow incontinence?
Occurs when there is chronic urinary retention due to obstruction
Results in overflow of urine and incontinence occurs without the urge to pass urine
What can cause overflow incontinence?
Anticholinergics
Fibroids
Pelvic tumours
MS
Diabetic neuropathy
Spinal cord injuries
More common in men
Refer to urodynamic testing
What are the risk factors for urinary incontinence?
Age
Postmenopause
BMI
Previous pregnancies and vaginal deliveries
Pelvic organ prolapse
Pelvic floor surgery
MS
Cognitive impairment and dementia
What modifiable lifestyle factors are there with incontinence?
Caffeine
Alcohol
Medications
BMI
How is severity assessed?
Frequency of urination
Incontinence
Night-time urination
Pad use and changes of clothing
What is assessed on examination?
Pelvic organ prolapse
Atrophic vaginitis
Urethral diverticulum
Pelvic masses
Asking the patient to cough and watch for leakage from the urethra
How is the strength of the pelvic muscles assessed?
Ask woman to squeeze
Graded using modified Oxford grading system
0 No contraction
1 Faint contraction
2 Weak contraction
3 Moderate contraction with some resistance
4 Good contraction with resistance
5 Strong contraction, a firm squeeze and drawing inwards
What investigations are used?
Bladder diary
Urine dip
Post-void residual bladder volume
Urodynamic testing
What are urodynamic tests?
Assesses presence and severity of urinary symptoms
Patients need to stop taking anticholinergics before tests
Catheter inserted into bladder and one into rectum
Catheters measure pressures in bladder and rectum
What outcome measures are taken in urodynamic testing?
Cystometry
Measures detrusor muscle contraction and pressure
Uroflowmetry
Flow rate
Leak point pressure
Patient asked to cough, move or jump as bladder is filled
Post-void residual bladder volume
Incomplete emptying
Video urodynamic testing
Filling bladder with contrast and taking X-rays as bladder empties
(Not routine)
How is stress incontinence managed?
Avoid caffeine, alcohol and overfilling
Avoid excessive or restricted fluid intake
Weight loss
Supervised pelvic floor exercises
Surgery
Duloxetine (SNRI antidepressant, used where surgery is less preferred)
