Urinary incontinece Flashcards
What is urinary incontinence
Complaint of involuntary loss of urine
What is stress urinary incontinence?
Complaint of involuntary loss of urine on effort or physical exertion including sporting activities, or on sneezing or coughing
what is urgency urinary incontinence?
Complaint of involuntary loss of urine associated with urgency
AKA overactive bladder
what increases risk of urinary incontinence?
-Increase age
-Obesity
-Smoking
-Exercise (high impact)
-Post menopausal
-Hysterectomy
-previous pregnancies + vaginal delivery
-pelvic floor surgery
-neurological conditions (MS)
-cognitive impairement
peak age of urinary incontinence?
menopause
Examinations- urinary incontinence?
Examinations
* BMI
* Mobility
* Abdominal palpation (look for mass)
* Inspection external genitalia
* Assess for prolapse
* Assess for pelvic floor squeeze
* Neuro exam if appropriate
What causes stress urinary incontinence?
-Urethral hypermobility (found in women with impaired pelvic floor support)
-Intrinsic sphincter deficiency (due to denervation or weakness of sphincter mechanism)
what is the most common causative factor of stress urinary incontinence?
Childbirth (this denervates the pelvic floor)
Presentation of stress urinary incontinence?
leakage provoked by activity, coughing, laughing, sneezing, penetration etc.
investigations- urinary incontinence?
Urinalysis +/- culture to check for UTI
Frequency volume chart: 3 days
Ultrasound
Cystoscopy
Urodynamics
conservative management for stress urinary incontinence?
Weight management
Pelvic floor muscle training
Incontinence ring
Medical management for stress urinary incontinence?
Vaginal oestrogen
Duloxetine (used last line after surgical)
Surgical management for stress urinary incontinence?
- Bulkamid
-Synthetic substance is injected into the walls of urethra to increase its size to allow it to remain closed under pressure - Fascial slings
-A sling is made using the rectus sheath and placed behind the urethra to support it - Colposuspension
-Lifting up the tissue around the neck of the bladder, and suspending it to the ileopectineal ligament using non absorbable synthetic stitches
Cause of urgency urinary incontinence?
-Caused by detrusor instability or hyperreflexia leading to involuntary detrusor contraction
-This may be idiopathic or secondary to neurological problems such as stroke, Parkinson’s disease, multiple sclerosis, dementia or spinal cord injury
presentation of urgency urinary incontinence?
describes the sensation of urgently needing to pass urine, resulting in involuntary leakage
conservative management- urgency urinary incontinence/ over active bladder
Bladder retraining= first line
-Fluid management (drinking enough fluids)
-Weight management
-Eliminating caffeine, fizzy drinks, alcohol
medical management- urgency urinary incontinence/ over active bladder
-Vaginal oestrogen
-Anticholinergics (tolterodine, soliphenacin)
-β3-adrenoceptor agonist (mirabegron)
-Desmopressin (nocturia) (not used as commonly)
examples of anticholinergics used in medical mangement of urinary incontinence/ overactive bladder?
Tolterodine
Soliphenacin
how do anticholinergics work?
Anticholinergics inhibit involuntary contraction - stops detrusor from contracting inappropriately by blocking the antimuscarinic receptors
would you give someone with cognitive decline an anticholinergic (tolterodine, soliphnocin)
no- as they can increase cognitive decline
how does Mirabegron (B3- adrenoceptor agonist) work to help urinary incontincen?
-inreases relaxation of detrusor by activating the Mg receptors
surgical management- urgency urinary incontinence/ over active bladder
used if medical management fails
First line= Botox
-Percutaneous posterior tibial nerve stimulation (after botox failed)
-Augmentation cytoplasty (last resort)
what is bulkamid?
surgical treatment for stress urinary incontinence
-inject synthetic substance into walls of urethra to increase its size to allow it to remain closed under pressure
what are fascial slings?
surgical treatment for stress urinary incontinence
rectus sheath is used to be made into a sling and put behind the urethra to support it
what is colpususpension?
surgical treatment for stress urinary incontinence
lifting up tissue around the neck of the bladder and suspending it from the ilepectal ligament to support it
what neurological problems could cause urgency urinary incontinence AKA overactive bladder syndrome?
-Parkinsons
-MS
-stroke
-Dementia
-Spinal cord degeneration
what investigation is done if first line treatment doesnt work for urinary incontinence?
urodynamic testing
(1st line= bladder training for atleast 6 weeks)
SE of botox treatment for urgency urinary incontinence
could paralyse detrusor muscles and so could need catheter
what is mixed urinary incontinence?
involuntary leakage of urine associated with both urgency and exertion, effort, sneezing or coughing
causes of mixed urinary incontinence?
Can be caused by chronic urinary retention or a blockage to the outflow of urine
Causes:
-congenital structural abnormalities
-Pelvic mass (fibroids, tumours)
-Anticholinergic medication
-Neurological conditions: MS, diabetic neuropathy and spinal cord injuries
A 34-year-old woman from Chad presents with continuous dribbling incontinence after having her 2nd child. Apart from prolonged labour the woman denies any complications related to her pregnancies. She is normally fit and well.
What is the most likely diagnosis?
vesico vaginal fistula
presentation- vesico vaginal fistula?
Continuous dribble incontinence after prolonged labour or labour in developing world
investigations- vesico vaginal fistula?
Urinary dye studies
who should oxybutin be avoided in and why?
avoid in elderly patients
-increases chance of falls
