Urinary Incontinence Flashcards
What is Urinary Incontinence?
Involuntary leakage of urine
What are the 2 types of Urinary Incontinence?
- Urge
- Stress
What is Mixed Incontinence?
Pt with features of both types of incontinence (most common)
What is the definition of Stress Incontinence?
Involuntary urine leakage @ increased intra-abd pressure
When is Stress Incontinence typically seen?
After childbirth (aka most common causative factor)
What is Stress Incontinence due to?
Weakness of pelvic floor + sphincter muscles
What occasions does urine leak out with Stress Incontinence? (4 things)
- Laughing
- Coughing
- Sneezing
- Surprised
What is Urge incontinence caused by?
Overactivity of detrusor muscle
What is another name for Urge incontinence?
Overactive bladder
What are the RF for Urinary Incontinence? (8 things)
- Age
- BMI
- Postmenopausal
- Vaginal delivery
- Pelvic organ prolapse
- Pelvic floor surgery
- Neurological conditions (e.g MS)
- Cogn impairment / Dementia
What are the CF of Stress Incontinence? (3 things)
- Leakage @ exertion (ask pt to cough)
- SMALL volume leakage
- Prolapse of urethra + ant vaginal wall (@ exam)
What are the CF of Urge Incontinence? (4 things)
- Urgency
- Frequency
- Nocturia
- LARGE volume leakage
What are some triggers for urgency in Urge Incontinence? (2 things)
- Hearing running water
- Cold weather
What is the aim of the primary investigation for sus Incontinence?
Excluding UTI
What are the 2 main investigations for Incontinence?
- Frequency / volume charts
- Urodynamic studies
How do you distinguish between Stress vs Urge with Frequency / volume charts?
- Stress = Normal frequency
- Urge = Increased frequency
What is the point of doing Urodynamic Studies? (2 points)
- Done for Stress incontinence when considering surgery
- Used to confirm Dx + rule out detrusor over-activity
What is important a pt does before Urodynamic Studies are done?
Stop taking anticholinergic meds 5 days before
What are some important Modifiable lifestyle factors you should ask about in the Hx of sus Incontinence? (3 things)
- Caffeine / Alcohol consumption
- Meds
- BMI
What are you checking for @ examination of sus Incontinence? (5 things)
- Pelvic tone
- Pelvic organ prolapse
- Atrophic vaginitis
- Urethral diverticulum
- Pelvic mass
What are the CONSERVATIVE Mx options for Stress Incontinence? (4 things)
- X caffeine / alcohol / overfilling bladder
- Weight Loss
- TUC (e.g chronic cough)
- Pelvic floor exercises (supervised)
How long should Pelvic floor exercises be done for before considering Surgery?
3 months
What are the SURGICAL Mx options for Stress Incontinence? (2 things)
- Tension Free Vaginal Tape (TVT) (most common)
- Laparoscopic colposuspension
What does Tension Free Vaginal Tape (TVT) involve?
Tape placed under mid-urethra via small vaginal incision
When should someone have MEDICAL Mx for Stress Incontinence?
Woman doesn’t want / not suitable for surgery
What is the Medical Mx of Stress Incontinence?
Duloxetine (SNRI antidepressant)
What are the CONSERVATIVE Mx options for Urge Incontinence? (2 things)
- X caffeine / alcohol / overfilling bladder
- Bladder retraining
What are the MEDICAL Mx options for Urge Incontinence? (2 things)
- Anticholinergics (e.g oxybutynin)
- Mirabegron (alternative to anticholinergics)
What are the Side fx of using Anticholinergics for Urge Incontinence? (5 things)
- Confusion
- Dry eyes / mouth
- Blurred vision
- Arrhythmias
- Constipation
What are the CI for taking Anticholinergics for Urge Incontinence? (3 things)
- Acute angle glaucoma
- Myasthenia gravis
- GI obst
What are the CI for taking Mirabegron for Urge Incontinence?
Uncontrolled HTN
Who is SURGICAL Mx of Urge Incontinence reserved for?
Only those with debilitating symptoms
What is the SURGICAL Mx option for Urge Incontinence?
Detrusor myomectomy + Augmentation Cystoplasty
(using bowel tissue to enlarge bladder)
Which Incontinence type is SURGICAL BEFORE MEDICAL Mx?
Stress Incontinence
(doc gets STRESSED n instantly does da Surgery)
