Urinary Incontinence Flashcards
What is urge incontinence (aka overactive bladder) caused by?
Overactivity of the detrusor muscle of the bladder.
The typical description is of suddenly feeling the urge to pass urine, having to rush to the bathroom and not arriving before urination occurs.
What is stress incontinence caused by?
Weakness of the pelvic floor and sphincter muscles. This allows urine to leak at times of increased pressure on the bladder.
What is overflow incontinence?
Chronic urinary retention due to an obstruction to the outflow of urine. Chronic urinary retention results in an overflow of urine, and the incontinence occurs without the urge to pass urine.
What can cause overflow incontinence?
- Anticholinergic medications
- Fibroids
- Pelvic tumours
- Neurological conditions e.g. MS, diabetic neuropathy, spinal cord injuries
Is overflow incontinence more common in men or women?
Men
What is the management of women with suspected overflow incontinence?
Should be referred for urodynamic testings and specialist management.
What are risk factors for urinary incontinence?
- Increased age
- Postmenopausal status
- Increase BMI
- Previous pregnancies and vaginal deliveries
- Pelvic organ prolapse
- Pelvic floor surgery
- Neurological conditions, such as multiple sclerosis
- Cognitive impairment and dementia
What modifiable lifestyle factors contribute to urinary incontinence symptoms?
- Caffeine consumption
- Alcohol consumption
- Medications
- Body mass index (BMI)
How do you assess the severity of urinary incontinence symptoms?
- Frequency of urination
- Frequency of incontinence
- Nighttime urination
- Use of pads and changes of clothing
When assessing urinary incontinence, what should examination look for in particular? (4)
- Pelvic organ prolapse
- Atrophic vaginitis
- Urethral diverticulum
- Pelvic masses
What is the modified Oxford grading system?
0: No contraction
1: Faint contraction
2: Weak contraction
3: Moderate contraction with some resistance
4: Good contraction with resistance
5: Strong contraction, a firm squeeze and drawing inwards
What investigations are needed for urinary incontinence?
- Bladder diary (3+ days, fluid intake and urination and incontinence episodes, mixture of work and leisure days)
- Urine dipstick testing (for infection, microsopic haematuria)
- Post-void residual bladder volume
- Urodynamic testing for investigate patients with urge incontinence not responding to first-line medical treatments, difficulties urinating, urinary retention, previous surgery or an unclear diagnosis. It is not always required where the diagnosis is possible based on the history and examination
How long before urodynamic tests should anticholinergic and bladder related medications be stopped?
5 days
What does cystometry measure?
Measures the detrusor muscle contraction and pressure
What does uroflowmetry measure?
Flow rate
