Urinary incontinence Flashcards
What is non-surgical management of urinary incontinence?
Lifestyle interventions (caffeine/fluid intake/BMI)
Pelvic floor muscle training
Bladder retraining (6 weeks) - increase time of urgency - sit still on firm chair until urge goes
What is urinary incontinence?
Involuntary loss of urine that is objectively demonstrable and is a social or hygienic problem
What are risk factors for urinary incontinence?
Damage during childbirth
Pelvic floor muscles weakened
Menopause/tissue atrophy – Connective tissue/collagen
Chronic increased abdominal pressure - Obesity, cough, straining
What are the classifications of urinary incontinence?
Stress incontinence
Overactive bladder incontinence
Mixed incontinence
What is the pathophysiology of stress incontinence?
Abnormal bladder neck/proximal urethra descent
Urethral scarring
Lack of oestrogen
Pelvic floor injury
What are symptoms of stress incontinence?
Involuntary leakage on cough/laugh/sneeze
Leakage on intercourse
Urgency/frequency
What are symptoms of overactive bladder?
Frequency
Urgency
Sudden compelling desire to void, difficult to defer
Leakage associated with urgency
Nocturia
“Toilet mapping”
What are investigations for urinary incontinence?
Urinalysis +/- microscopy & culture
Bladder diary
Quality of life questionnaire
Pad testing (not routine)
USS
What is urodynamic stress incontinence?
Leakage on increased abdominal pressure in the absence of rise in detrusor pressure
What is detrusor overactivity?
Spontaneous or provoked contractions
What is surgical treatment of urinary incontinence?
Bladder neck injections
Colposuspension
What is conservative treatment of overactive bladder?
Avoid irritants/stop smoking
Lose weight
Control co-morbidities
Behaviour therapies
What is medical treatment of overactive bladder?
Anticholinergic medication
Mirabegron (B3 adrenoreceptor agonist)
What is surgical treatment of overactive bladder?
Intravesical Botox
Nerve stimulation (TENS, PTNS) (not recommended)
Augmentation cystoplasty
Urinary diversion
