urinary incontinence Flashcards
what is stress urinary incontinence?
leakage on effort, exertion, sneezing or coughing
what causes stress urinary incontinence?
occurs as a result of bladder neck/urethral hypermobility and/or neuromuscular defects causing intrinsic sphincter deficiency
urine leaks when urethral resistance is exceeded by increased abdo pressure
what is urge urinary incontinence?
leakage accompanied by or immediately preceded by urgency.
may be due to bladder overactivity or less commonly due to pathology that irritates the bladder (infection, tumour, stone)
what warrants an urgent urology referral?
nocturnal enuresis in elderly men that wasn’t happening before
what does a constant leakage of urine suggest?
a fistulous communication between the bladder and vagina, or the presence of an ectopic ureter draining into the vagina
what controls the urge to pee?
the pontine micturition centre
what are some risk factors for incontience?
female
Caucasian
neurological disorders
anatomical disorders
child birth
pelvic, perineal and prostate surgery
radical pelvic radiotherapy
diabetes
what are some promoting factors for incontinence?
smoking (causes cough)
obesity
UTI
increased fluid intake
poor nutrition
age
cognitive deficit
poor mobility
oestrogen deficiency
what are some red flag symptoms in incontinence?
pain
haematuria
recurrent UTI
significant voiding/obstructive symptoms
history of pelvic surgery/radiotherapy
what are some investigations for incontinence?
bladder diary (frequency and volume)
urinalysis +/- culture
flow rate
pad testing
bloods
imaging
cystoscopy (complex cases)
what is cystometry?
measures the pressure in the bladder
tries to establish if the bladder is where the issues are
what are some conservative treatments of incontinence?
pelvic floor exercises
lifestyle modifications- WL, smoking cessation, avoid constipation, limit caffeine
what are some pharmacological treatments of incontinence?
duloxetine (increases sphincter muscle activity during bladder filling)
what are the surgical treatments of incontinence?
injection therapy- injection of bulking materials into the bladder neck to increase outlet resistance
main indication is for female stress incontinence secondary to intrinsic sphincter deficiency
what treatment is used to treat female stress incontinence caused by urethral hypermobility?
retropubic suspension
requires good vaginal mobility
success rate of 70% after 5 years
what is used to prevent urethral movement
pubovaginal slings
what are the features of an artificial urinary sphincter?
- an inflatable cuff placed around the bulbar urethra or bladder neck
- a pressure regulating baloon placed extraperitoneally in the abdomen
- an activating pump in the scrotum or labia majora
what is an overactive bladder?
a symptom syndrome that includes urgency with or without incontinence, usually with frequency and nocturia
usually caused by bladder (detruser) overactivity
what is the conservative treatment of an OAB?
pelvic floor exercises
behavioural modifications
what can be used for bladder overactivity?
anticholingeric (antimuscarinic) drugs
eg fesoterodine
what is the last line option of an OAB?
botox- injected at multiple (20) sites under the bladder mucosa or into detrusor, sparing the trigone
