Urinary Incontinence Flashcards
Types of urinary incontinence
Stress
Urgency
Mixed
Overflow
Treatment for stress incontinence
Pelvic floor exercises - before urodynamics
Duloxetine
Sling/ tape - surgery
Intramural urethral bulking
Vesicular pressure components
Detrusor pressure + abdominal pressure
Sphincter pressure components
Internal sphincter pressure + external sphincter pressure + abdominal pressure + pelvic floor pressure + urethral mucosa
Investigating incontinence
Bladder diary
HbA1c - nocturia
USS - renal pathology
Urine analysis
Urine dynamics
Post void residual bladder volume
Cystoscopy
Advice for incontinence
Avoid caffeine, fizzy drinks and alcohol
Regular toilet visits
Double voiding
Keep hydrated but not too much
History of incontinence
Triggers? Nocturia? Frequency? Hesitancy? Fluid intake?
Obstetric history?
Surgical history?
Examination for incontinence
Scars
Abdominal distension
Prolapse
Pelvic floor tone
Visible incontinence
Obesity
CNS
Bimanual examination
Treatment for detrusor overactivity - urgency
Bladder training
Antimuscarinics
Mirabegron
Botulinum injection - botox
Posterior tibial nerve stimulation
Sacral nerve stimulation
Clam enterocystoplasty
Antimuscarinics for urge incontinence
- Oxybutynin
- Tolterodine
- Trospium
- Propiverine
- Solifenacin
Pathophysiology of urge incontinence
Overactivity of the detrusor muscle of the bladder
Presentation of urge incontinence
Not being able to hold urine in when the urge to urinate occurs
Presentation of stress incontinence
Urine leakage with raised intra abdominal pressure such as laughing, coughing or surprise
Pathophysiology of stress incontinence
Weakness of the pelvic floor and sphincter muscles
Overflow Incontinence
Occurs with chronic urinary retention due to an obstruction to the outflow of urine
Causes of overflow incontinence
Anticholinergic medications
Fibroids
Pelvic tumours
Neurological conditions such as multiple sclerosis, diabetic neuropathy and spinal cord injuries
Women with overflow incontinence
More rare in women
Referred for urodynamic testing and specialist management
Risk Factors for Urinary Incontinence
Increased age
Postmenopausal
Increase BMI
Previous pregnancies and vaginal deliveries
Pelvic organ prolapse
Pelvic floor surgery
Neurological conditions, such as multiple sclerosis
Cognitive impairment and dementia
Urodynamic Testing
Thin catheter is inserted into the bladder and another into the rectum.
Measure the pressures in the bladder and rectum for comparison
Intramural urethral bulking
Injections around the urethra to reduce the diameter and add support
Side effects of anticholinergic medication
Dry mouth and eyes,
Urinary retention
Constipation
Postural hypotension.
Cognitive decline, memory problems and worsening of dementia
When is mirabegron contraindicated
Uncontrolled hypertension
Requires blood pressure monitoring
