Urinary incontinence Flashcards
What are the types of urinary incontinence
Urge incontinence
Stress incontinence
What is urge incontinence
Overactivity of the detrusor muscle of the bladder
How does urge incontinence present
Sudden urge to pass urine, rush to bathroom, not neccessaruly in time
Conscioious about toilet being available at all times
What is stress incontinence
Weak pelvic floor muscles and sphincter muscles - urine leaks when increased pressure on bladder eg laugh, cough
What is mixed incontinence
urge incontinence and stress incontinence
What is overflow incontinence and who is it more common in
Chronic urinary retention due to obstruction of flow of urine, incontinence without urge to pass urine
More common in men
What can cause overflow incontinence
Anticholinergics
Fibroids
Pelvic tumours
Nuerological conditions eg MS neuropathy, spinal cord injuries
Risk factors for urinary inctoninence
Increased age
Postmenopausal status
Increased BMI
Prev pregnancies and vaginal deliveries
Pelvic organ prolapse
Pelvic floor surgery
Neurological conditions eg MS
Cognitive impairment and dementia
What should be done if women present with overflow incontinence
Referred for urodynamic testing and specialist management
What modifiable risk factors can contribute to incontince
Caffeine
Alcohol
Medications
BMI
Severity incontinence questions to ask
Frequency urination
Frequency incontinence
Nighttime urination
Ue of pads and changes of clothing
What should examination for urinary incontinence assess
Pelvic tone and examine for:
Pelvic organ prolapse
Atrophic vaginitis
Urethral diverticulum
pelvic masses
Ask patient to ocugh and watch for leakage
How assess pelvic muscle contractions
Bimanual examination
Ask woman to squeeze against fingers
How grade pelvic muscle contractions
0 - no contraction
1 - faint contraction
2 - weak contraction
3 - moderate contraction with some resistnace
4 - good contraction with resistance
5 - strong contraction a firmsqueeze, drawing inwards
Investigations for incontinence
Bladder diary completed
Urine dipstick
Post void residual bladder volume (bladder scan)
Urodynamic testing
wHY DO URINE dipstick in urine incontinence
assess infection, microscopic haematuria and other path
What does a bladder diary contain
should be completed, tracking fluid intake and episodes of urination and incontinence over at least three days. There should be a mix of work and leisure days.
What is urodynamic testing used to investigate
Urge incontinence that isnt responding to first line medical treatments, difficulties urinating, urinary retention, prev surgery or unclear diagnosis
What do patients need to do 5 days before urodynamic test
Stop taking anticholinergic and bladder related medications around five days before tests
What do patients need to do 5 days before urodynamic test
Stop taking anticholinergic and bladder related medications around five days before tests
How is a urodynamic test carried out
Thin catheter inserted into bladder, another into rectum. Used to measure differences in pressure to compare
What outcomes are measured in urodynamic testing
Cystometry
Uroflowmetry
Leak point pressure
Post void residual bladder volume
Video urodynamic testing - only when necessary, not routine
What does cystometry measure
Detrusor muscle contraction and pressure
What does uroflowmetry and post void residual bladder volume measure for
Flow rate
Incompltete emptying of bladder
What is leak point pressure
point at which bladder pressure results in leakage of urine
Patient asked to cough, move or jump when bladder filled to various capacities
Assess for stress incontinence
What does video urodynamic testing test for
Contrast and taking x ray images as bladder emptied. not routine
Management of stress incontinence
Avoid caffeine, diuretics and overfilling bladder
Avoid excessive or restricted fluid intake
Weight loss (if appropriate)
Supervised pelvic floor exercises
Surgery
Duloxetine - SNRI second line where surgery less preferred
What need to do before will consider surgery for incontinence
for at least three months before considering surgery
What do for pelvic floor exercises
at least 8 contractions, 3 x daily
What are the surgical options for incontinence
Tension-free vaginal tape
Autologous sling procedures
Colpsuspension
Intramural urethral bulking
What is TVT
procedures involve a mesh sling looped under the urethra and up behind the pubic symphysis to the abdominal wall. This supports the urethra, reducing stress incontinence.
Autologous sling procedures
work similarly to TVT procedures but a strip of fascia from the patient’s abdominal wall is used rather than tape
What is colposuspension
Stitches connecting anterior vaginal wall forwards and adding support to the urethra
What is intramural urethral bulking
Involves injections around urethra to reduce diameter and add support
What cna do if stress incontinence cuased by neurorological disorder
Artificial urinary sphincter
pump inserted labia inflates deflates cuff around urethra, allowing women to control continence manually
Management of urge incontinence
Bladder retraining = for at least 6 weeks = first line
Anticholinergic medication
Mirabegron
Invasive procedures - medical treatment fialed
Example of anticholinergics used for incontinence
Oxybutinin, tolterodine and solifenacin
Anticholinergic side effects, why especially difficult in older patients
Dyr mouth, eyes, urinary retention, constipation and postural hypertension
Can lead to cognitive decline, memory problems and worsening dementia
What is mirabegon contraindicated in
Uncontrolled HPTN
BP monitored refuarlty
How can mirabegon lead to stroke
Beta 3 agnoitst, stimulating sympathetic nervous system -> raised BP -> hypertensive crisis, increased risk TIA and stroke
What are invasice options for overactive bladder failed repsonse medicine
Botulinum toxin tyoe A injection into bladder wall
Percutaneous sacral nerve stimulation
Augmentation cystoplasty - bowerl tissue enlarge bladder
Urinary diversion - redirect to urostomy in abdomen
