Urinary Incontinence Flashcards
What organs are in the upper urinary tract?
Kidneys and ureters.
What organs are in the lower urinary tract?
Bladder and urethra.
Which nerves are for sympathetic (storage) of bladder?
T10-L2
Contraction of urethra
Relaxation of the bladder
Which nerves are for parasympathetic (voiding) of the bladder?
S2-S4
Contraction of bladder
Relaxation of urethra
Which nerve controls voluntary contraction and relaxation of the urethra?
Pudendal nerve - contracts to hold in urine.
Which higher centre controls micturition?
The Pons - The pontine micturition centre - prevents micturition even against a full bladder.
Which higher centre controls micturition?
The pontine micturition centre - controls sympathetic, parasympathetic pathways.
What is stress incontinence?
Involuntary leakage on effort or exertion (increased abdominal pressure).
What is urge incontinence?
Also known as overactive bladder.
Involuntary leakage accompanied by or just after the sense of urgency.
What is mixed urinary incontinence?
Urge incontinence and stress incontinence.
What is mixed urinary incontinence?
Urge incontinence and stress incontinence.
Which incontinence is most common in younger people <30?
urge incontinence
Which incontinence is most common in older people >30?
Stress incontinence.
Which incontinence is most common in older people >30?
Stress incontinence.
What are the risk factors for urge incontinence?
Recurrent UTI
High BMI
Older
Smoking
Caffeine
What are the risk factors for stress incontinence?
Surgery (hysterectomy)
Pregnancy
Childbirth - especially vaginal delivery (denervation of nerves and damage)
Increased intra abdominal pressure
What are the most important risk factors of stress incontinence?
Pregnancy and childbirth.
What are the contraindications for oxybutynin?
>65yrs (women)
Anti-depressants
Anti-psychotics
Glaucoma
What is the role of antimsucarinic medication in urinary incontinence?
Acetylcholine is the primary neurotransmitter which binds to receptors on the detrusor muscle causing contraction. Anticholinergics help inhibit this.
How many times should someone pee during the night?
Increases by 1 for each decade starting at 60yrs.
70yrs - 2x.
80yrs - 3x.
What investigations should be done for urinary incontinence?
Urine dipstick - to exclude UTI.
Post voiding residual volume assessment.
3 day urinary diary
Urodynamics - ONLY if surgery is contemplated
How can menopause cause incontinence?
Lack of oestrogen causes urogenital atrophy.
What is the first line of management for all urinary incontinence?
Conservative - avoid caffeine, sugar, fizzy drinks, too much to drink, alcohol.
+ Pelvic floor exercises.
Stop smoking
lose weight
avoid constipation/chronic cough etc.
What is the Oxford score?
This is assessed during vaginal palpation.
0 - no pelvic floor muscle strength
4 - a good pelvic floor muscle strength
5- strong pelvic floor muscle strength
What is the only medication used to manage stress incontinence?
Duloxetine.
Used when - conservative management fails AND patient is not a candidate for surgery.
What is the surgical management of urinary stress incontinence?
MID URETHRAL SLING/TVT - gold standard.
Colposuspension and fascia slings (lower part of the vagina is stitched to a ligament behind the pubic bone to decrease transmission pressure and compression)
Bulking agents into bladder neck.
What is the medical treatment for urge incontinence/OAB?
Anticholinergics (inhibit parasympathetic activity on detrusor muscle) - oxybutynin, tolterodine, Fesoterodine, Solifenacin
What is the surgical treatment for urge incontinence?
Botox injection - to paralyse detrusor muscle.
sacral nerve modulation.
What is urgency?
Sudden desire to pass urine that’s difficult to defer.
What is urge incontinence?
Involuntary leakage that has urgency before or during it.
What is frequency>
Usually accompanies urgency (with or without incontinence) - when the patient complains they void too often >7x.
What is noctirua>
When the individual has to wake at night one or more times to void - accompanies urgency with or without urge incontinence.
What is a treatment for over active bladder?
Bladder retraining - increasing the time before going to the toilet.
Antimuscarinics.
Tri-cyclic antis depressants - imipramine.
Where is sacral neuromodulation targeted?
S2-S4.
