Urinary incontinence Flashcards
What is urinary incontinence?
The involuntary leakage of urine
What are the different types of incontinence?
Stress Urge Mixed Overflow Continuous
What is stress urinary incontinence?
When the urine leakage is due to rising intra-abdominal pressure - such as when coughing, straining, laughing or lifting.
What is the pathophysiology behind stress urinary incontinence?
Weakened pelvic floor muscles
What are the risk factors for stress urinary incontinence?
Post partum Chronic constipation Obesity Post menopausal Pelvic surgery - such as TURP
What is the pathophysiology of urge incontinence?
Detrusor hyperactivity (overactive bladder) means there is more bladder contraction –> higher pressure –> leakage of urine
What can cause urge incontinence?
Neurogenic causes - e.g. previous stroke Infection Malignancy Idiopathic Certain medications
What is mixed urinary incontinence?
Combination of stress and urge incontinence
What can cause overflow urinary incontinence?
Chronic urinary retention
Prostatic hyperplasia (most common)
Spinal cord injury
What is the pathophysiology behind overflow urinary incontinence?
Progressing stretching of the bladder wall = damage to efferent fibres of sacral reflex + loss of bladder sensation.
Urine fills the bladder = becomes distended with high pressure = constant dribbling of urine.
What is continuous urinary incontinence?
Constant leakage of urine
What can cause continuous urinary incontinence?
Anatomical abnormalities
- ectopic ureter
- bladder fistulae
Or due to sever overflow incontinence
What investigations can be done for urinary incontinence?
Bladder diaries
Examinations - e.g. DRE
Midstream urine dipstick
Post-void bladder scans
Specialist tests can also be done - e.g. urodynamics, measuring pressures, cystoscopy
What is the conservative management for stress urinary incontinence?
Lifestyle advice - e.g. weight loss, reduce caffeine intake, avoid excessive fluid intake
Pelvic floor muscle training - for at least 3 months
Duloxetine - stronger urethral contractions (go over mechanism of this)
What is the conservative management for urge urinary incontinence?
Lifestyle advice - e.g. weight loss, avoid excessive fluid intake
Anti-muscarinics - e.g. oxybutynin to inhibit detrusor contraction
Anticholingerics - solifenacin
Mirabegron
Bladder training
