Urinary incontinence Flashcards
What is urinary incontinence?
The involuntary leakage of urine
What are the two main types of urinary incontinence?
Stress incontinence
Urge incontinence
Mixed
Describe stress incontinence
Involuntary leakage of urine during increased intra-abdominal pressure - in the absence of a detrusor contraction
When is stress incontinence commonly seen?
After childbirth
Oestrogen defiency states
Pelvic surgery
Pelvic irradiation
What is the mechanism behind stress incontinence?
Pelvic floor denervation
Describe urge incontinence
Prescence of urgency, usually with frequency and nocturia in the abscence of UTI or other obvious pathology
What is urge incontinence otherwise known as?
Overactive bladder syndrome
List some causes of urge incontinence
Multiple scelrosis
Spina bifida
Idiopathic
Pelvic/incontinence surgery
What investigation is used to detect over-activity of detrusor muscle in urge incontinence?
Urodynamic testing
Describe overflow incontinence
Leakage of urine from a full urinary bladder, often in the absence of any urge to urinate
What is a bladder fistula?
Opening between the bladder and another organ - vagina or rectum
What is an urethral diverticulum
Outpocketing of the urethra into the anterior vaginal wall
What is functional incontinence?
Physical or mental barriers that prevent the patient reaching the toilet
What is temporary incontinence
Due to reversible factors such as constipation and UTI
What are the clinical features of stress incontinence
Leakage on coughing, sneezing exercise
Leakage volume is often small and coincides with physical stress
What may be seen on examination in someone with stress incontinence?
Prolapse of the urethra and anterior vaginal wall
Asking a patient to cough with a semi-full bladder may demonstrate the incontinence
What are the clinical features from history of a person with urge incontinence?
Urgency
Frequency
Nocturia
Trigger factors - running water, cold weather
Large volumes of leakage compared to stress incontinence
Which type of incontinence results in larger volumes leaked?
Urge incontinence
What is urgency?
A sudden and compelling desire to pass urine which is difficult to defer
What is Nocturia?
Having to wake one or more times during the night to pass urine
What is day time frequency
A perception of voiding urine too often during the day
What must you rule out in a patient presenting with urinary incontinence?
UTI
How are urge and stress incontinence investigated?
Frequency/volume charts
Urodynamic studies
What is seen on frequency/volume charts in stress incontinence?
Normal frequency and bladder capacity
What is seen on frequency/volume charts in urge incontinence?
Increased frequency
What are urodynamic studies useful for?
Performed in stress urinary incontinence when considering surgery to confirm diagnosis and rule out concomitant detrusor over-activity
Describe the conservative management of stress urinary incontinence
Lifestyle changes - weight loss and smoking cessation
Treatments of risk factors - such as chronic cough/other conditions which raise the intrabdominal pressure
Supervised pelvic floor muscle training - 3 months at least
Describe the surgical management of stress urinary incontinence
Tension free vaginal tape - Most commonly performed operation with high cure rate
Burch colposuspension/Laparoscopic colposuspension - rarely performed
Peri-urethral injection - older patients not suitable for surgery
Transobturator mid-urethral slings
Describe a tension free vaginal tape
Involves a tape being placed under the mid urethra via a small vaginal incision
Which complication of tension free vaginal tape is causing the most controversy at the moment?
Erosions into the vagina, urethra and bladder resulting in chronic pain
Describe the medical management of stress incontinence
Duloxetine - after surgical intervention or for women who surgery is not appropriate
Describe the conservative management of urge incontinence
Lifestyle changes - fluid intake and aversion to caffeine and diuretics
Bladder retraining
Describe the medical management of urge incontinence
Anticholinergic medication
Intravaginal oestrogens
Botulinum toxin A
Neuromodulation and sacral nerve stimulation
List some anticholinergic medications used to treat urge incontinence
Oxybutynin
Solifenacin
Tolterodine
What are some side effects of anticholinergic medication?
Xerophthalmia, xerostomia, constipation, blurred vision, arrhythmias, confusion
What are the contraindications to anticholinergic medication?
Acute angle closure gluacoma
Myasthenia gravis
GI obstruction
Describe the surgical management of urge incontinence
Detrusor myomectomy and augmentation cytoplasty
When is surgical management used for urge incontinence?
As a last resort only
