urinary incontinence Flashcards
urge incontinence
due to overactivity of detrusor muscle - ‘overactive bladder’
urge incontinence - presentation
sudden urge to pass urine
rush to toilet
incontinence
conscious about knowing where nearest toilet is
stress incontinence
weakness of pelvic floor and sphincter muscles
urine leak at times of increased pressute
stress incontinence - presentation
urinary leakage when laughing, coughing
overflow incontinence
occur when chronic urinary retention due to obstruction
no urgency
more common in men
risk factors
inc age postmenopausal inc BMI prev pregnancies, vaginal deliveries POP pelvic floor surgery neuro conditions e.g. MS cognitive impairment
assessment - assess for modifibale risk factors
caffeine consumption
alcohol
medications
BMI
assessment - assess severity
frequency of urination
frequency of incontinence
nighttume urination
use of pads, changing clothes
Ix
bladder diery
dipstix
post-void residual bladde volume
urodynamic testing
urodynamic tests
objectively assess presence and severity of urinary symptoms
need to stop anticholinergic and bladder-related medications prior
urodynamic tests - measurements taken
cystometry
uroflowmetry
leak point pressure
post-void residual bladder volume
Mx stress incontinence
avoid caffeine + diuretics
pelvic floor exercises (3+mo before surgery)
surgery
duloxetine 2nd line if surgery not preferred
Mx stress incontinence - surgical
tension-free vaginal tape
autologous sling procedure
colposuspension
intramural urethral bullking
Mx urge incontinence
bladder retraining for 6wks (1)
anticholinergic medication
mirabegron
invasive procedure if medical Rx fails
anticholinergic side effects
dry mouth dry eyes urinary retention constipation postural hypotension cognitive decine, worsening of dementia
