Urinary Incontinence Flashcards
CWhat are the two types of urinary incontinece?
Stress incontinence
Urge incontinence
What is the cause of urge incontinence?
Overactivity of the detrusor muscle, which causes the sudden urge to urinate
What is the cause of stress incontinence?
Weakness of the pelvic floor and sphincter muscles, which allows urine to leak when pressure is high in the bladder
What is overflow incontinence?
Can occur when there is chronic urinary retention due to an obstruction to outflow. This results in an overflow of the urine, without the urge to pass urine.
What are the risk factors for urinary incontinence?
Increased age
Postmenopausal status
Increased BMI
Previous pregnancies and vaginal deliveries
Pelvic organ prolapse
Pelvic floor surgery
Neurological conditions
Cognitive impairment
What modifiable lifestyle factors can contribute to symptoms?
BMI
Caffeine consumption
Alcohol consumption
Medications
What investigations can be used to diagnose urinary incontinence?
Cough stress test
Bladder diary
Urinalysis
Post-voidal residual measurement
Urodynamic testing
What types of urodynamic testing can be performed?
Cystometry
Uroflowmetery
Leak point pressure
Post-void residual bladder volume
Video urodynamic testing
What is cystometry?
Measures detrusor muscle contraction and pressure
What is the first line management of urinary incontinence?
Conservative management
- Bladder training
- Pelvic floor exercises
- Avoiding alcohol and caffeine
- Weight loss
- Avoiding excess fluid intake
What is the second line management of urinary incontinence?
Medication
- Anticholinergics - oxybutynin (urgency)
- Mirabegron (urgency)
- Duloxetine (stress incontinence)
What are the side effects of anticholinergics?
Dry mouth
Dry eyes
Urinary retention
Constipation
Postural hypotension
What other management options exist for urge incontinence?
Botulinum toxin injection into the bladder wall
Percutaneous sacral nerve stimualtion
Augmentation cystoplasty - using bowel to increase the bladder size
How long should pelvic floor training be trialled for before further management?
3 months
