Urinary Incontinence Flashcards
What are the 3 points in urinary process where urinary symptoms present?
What urinary symptoms are associated with each?
Voiding= associated with obstructive pathology
- hesistancy
- poor or intermittent stream
- straining
- incomplete empyting
- terminal dribbling
Storage= associated with irritative pathology
- urgency
- frequency
- nocturia
- urinary incontinence
Post-micturition
- post-micturition dribbling
- sensation of incomplete empyting
What are the different types of incontinence?
Stress Urge Overflow Continous Neurogenic
What are the causes of stress incontinence?
What are the associated risk factors?
Intra-abdo pressure> urethral pressure due to:
-coughing
-straining
-lauhging
-lifting
Weakness of pelvic floor= leads to impaired urethral support
Risk factors:
- post-partum= damage to pelvic floor and urinary sphincters
- constipation
- post-menopausal= hormone changes leads to weakening of pelvic floor
- pelvic surgery i.e. TURP= damages external sphincter
What are the causes of urge incontinence?
What are the associated risk factors?
Overative bladder= hyperactive detrusor
Rise in intravesical pressure
Neurogenic i.e. stroke Infection Malignancy Idiopathic Medications i.e. cholinesterase inhibitors
What are the causes of overflow incontinence?
Chronic urinary retention due to lower urinary tract obstruction
-leads to bladder wall stretching which damages the efferent nerve fibres of sacral reflex leading to loss of bladder sensation i.e. cannot sense when bladder full
Gross distension
-building of intravesicular pressure
Lower urinary tract obstruction due to:
- prostatic hyperplasia
- spinal cord injury
- congenital defects
- bladder cancer obstructing neck of bladder
What investigations can be done for incontinence?
Bladder diary to see if underlying cause
QOL questionnaire to gauge impact
MSU for haematuria and infection
Post-voiding bladder scans
-low residue in overactive bladder
-high residue in LUT obstruction
Urodynamic assessment= measure of intravesical and intra-abdominal pressure to evaluate the pressure of detrusor muscle to be calculated
Outflow urodynamics
Cystoscopy
Intra-vesicular urogram
Vaginal speculum
MRI
How can stress incontinence be managed?
Pelvic floor training
Duloxetine= urethral contraction
Surgery= tension free vaginal tape or artifical urinary sphincter
How can urge incontinence be managed?
Antimuscarnics to inhibit detrusor
I.e. oxybutynin/tolterodine/mirabegron
Bladder training
Surgery
-botulinum toxin A injections and augmentation cystoplasty (insertion of sections of bowel into bladder wall to increase capacity)
How can overflow incontinence be treated?
Treat BPH
I.e. tamulosin
