Urinary Incontinence Flashcards

1
Q

what are the risk factors for urinary incontinence?

A
  • advancing age
  • previous pregnancy and childbirth
  • high BMI
  • hysterectomy
  • FHx
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2
Q

what is the cause of overactive bladder/urge incontinence?

A

detrusor overactivity

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3
Q

describe overactive bladdler/urge incontinence

A
  • urge to urinate is quickly followed by uncontrollable leakage
  • few drops –> complete bladder
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4
Q

describe stress incontinence

A

leaking small amounts when coughing or laughing

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5
Q

what is mixed incontinence?

A

urge + stress incontinence

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6
Q

what is outflow incontinence?

A

due to bladder outlet obstruction
e.g. due to prostate enlargement

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7
Q

what is functional incontinence?

A

comorbid physical conditions impair the patient’s ability to get to a bathroom in time

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8
Q

name some causes of functional incontinence

A
  • dementia
  • sedating medication
  • injury/illness
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9
Q

name the different classifications of urinary incontinence

A
  • overactive/urge
  • stress
  • mixed
  • outflow
  • functional
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10
Q

what is the initial investigation in urinary incontinence?

A
  • bladder diaries (min of 3 days)
  • vaginal examination
  • urine dipstick and culture
  • urodynamic studies
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11
Q

what is the initial management of urge incontinence?

A

bladder retraining (minimum of 6 weeks)

increase the intervals between voiding

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12
Q

what are the first line medications used in urge incontinence?

A

bladder stabilising drugs –> anti-muscarinics
* oxybutynin (immediate release)
* tolterodine (immediate release)
* darifenacin (once daily)

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13
Q

what anti-muscarinic should be avoided in frail older women?

A

oxybutynin (immediate release)

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14
Q

what is the alternative to anti-muscarinics in urge incontinence?

A

mirabegron (beta-3 agonist)

useful if concern about anticholinergic effects

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15
Q

what is the initial management of stress incontinence?

A

pelvic floor muscle training
8 contractions performed 3 times per day for minimum of 3 months

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16
Q

what is the surgical management of stress incontinence?

A

retropubic mid-urethral tape procedures

17
Q

what is the first-line medical management of stress incontinence?

A

duloxetine

18
Q

how does duloxetine help with stress incontinence?

A
  1. increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve
  2. increased stimulation of urethral striated muscles within the sphincter
  3. enhanced sphincter contraction

noradrenaline and serotonin reuptake inhibitor