Urinary incontinence Flashcards
What are the types of incontinence
urgency urge nocturia frequency stress incontinence mixed
What are the two main types of incontinence?
stress and overactive bladder (umbrella term for urgency, urge, nocturia…)
What is the mechanism of stress incontinence?
Weakening of urethral sphincter
What is the mechanism of overactive bladder
overactive detrusor muscle
What are the investigations for incontinence?
urine analysis +- MSU
pregnancy test
bladder diary
urodynamics
What is the management of stress urinary incontinence?
conservative- physiotherapy, lifestyle modifications, bladder training
nothing
surgery
List two surgeries for stress incontinence
autologous sling
colposuspension
urethral bulking agents
What is the management of overactive bladder?
do nothing conservative management medical treatment invasive therapy reconstructive surgery
What is the conservative management of OAB?
nurse-led
physio
reduce fluid intake
no caffeine
What is the medical treatment for OAB?
- anticholinergics
- B3 agonist
- duloxetine
- anitbiotics
Side effects of anticholinergics?
dry eyes
dry mouth
constipation
What is mirabegron?
B3 agonist
What is the contrainidcation for mirabegron?
prolongation of QT segment
uncontrolled hypertension
Name an example of anticholinergic
oxybutinin
tolterodine
solfenacin
Name one invasive treatment for overactive bladder
botox
What is sacral neuromodulation
treatment option for OAB, last resort
List three investigations for incontinence?
microbio urodynamics cystoscopy USS IV urography
List three triggers for stress urinary incontinence
cough, laugh, run, walk, weight lifting, skipping
List four causes of OAB
alcohol caffeine acute UTI previous surgery neurological- MS, stroke high urine production- diabetes, fluids, medications bladder abnormalities- tumours, stones
List four risk factors associated with urinary incontinence
divided into predisposing, promoting, and obstertic and gynae causes
family hx, anatomical abnormalities, neuro abnormalities
drugs, menopause, UTI, obesity, age
Pegnancy, pelvic surgery, prolapse
What lifestyle advice can you offer to someone with incontinence?
fluids- normalise intake
avoid caffeine, alcohol, carbonated drinks
diet, weight loss, smoking cessation, treat chronic cough and constipation
List two surgical options for SUI
biological sling
intramural bulking agents
colposuspension
How to divide bladder symptoms in history?
storage (before)
voiding (during)
post-micturation (after)
What are the red flags for bladder symptoms associated with incontinence
visible haematuria
microscopic hameaturia >50
suspected malignant mass from urinary tract
recurrent or persisting UTIs in older women + haematuria
