Stress incontinence (Complete) Flashcards
Define stress incontinence
Involuntary leakage of urine during activities that increase intra-abdominal pressure (e.g. coughing, sneezing)
What are the main risk factors for stress incontience?
Age (>65)
Pregnancy
Childbirth
Menopause
Obesity
Smoking
Chronic coughing
Previous pelvic surgery
What are the main clinical features of stress incontinence?
Leakage of urine in response to increased intra-abdominal pressure
What differentials should be considered alongside stres incontinence?
Bladder fistula
- Constant leakage
Urge incontinence
- Sudden urge to quickly followed by incontinence
Pelvic organ prolapse
- Sense of heaviness + vaginal bulge
UTI
- Increased frequency + dysuria, haematuria
Functional incontinence
What investigations should be conducted if stress incontinence suspected?
Bedside:
Bimanual and spectulum examination: Rule out prolapse
Urine dipstick/urinalysis: Rule out UTI
Bladder diary
Imaging:
Urodynamic studies: Evaluate bladder muscle function
What is the management for stress incontinence?
Conservative:
Behavioural modification:
- Reduce oral intake
- Avoid caffeine and alcohol
Pelvic floor muscle training
Surgical:
Culoposuspension
Autologous rectal fascial sling
Retropubic mid-urethral mesh sling
Application of intramural urethral bulking agents
Medicine:
Duloxetine: Considered only if surgical management not possible
What does pelvic floor muscle exercises entail?
Supervised (by physiotherapist) training including at least 8 contractions (Kegels) performed three times per day for a period of at least three months.
What is first-line if lifestyle modification is ineffective in managing symptoms?
Pelvic floor muscle training
If pelvic floor muscle training is ineffective what is next management option?
Surgical intervention
Give examples of surgical interventions used in management of stress incontinence
Culposuspension
Autologous rectal facial sling
Retropubic mid-urethral mesh sling
Application of intramural urethral bulking agents
Culposuspension
Autologous rectal fascial sling
Retropubic mid-urethral mesh sling
Intramural urethral bulking agents
What is considered for patients who are unsuitable for surgical management?
Duloxetine
Increases urethral sphincter tone
