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Urinary > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

What are the types of incontience?

A
  • stress urinary incontinence
  • urgency urinary incontinence
  • mixed urinary incontinence
  • overflow incontinence (chronic urinary retention)
  • functional incontinence
  • over active bladder
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2
Q

What is the most common type of incontinence?

A

Over active bladder

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3
Q

What is stress urinary incontinence?

A

The complaint of involuntary leakage on effort or exertion or sneezing or coughing
Due to an increase in intra-abdominal pressure/stress

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4
Q

What is urgency urinary incontinence?

A

The complaint of involuntary leakage of urine accompanied by or immediately proceeded by urgency
Due to involuntary contraction of bladder muscles

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5
Q

What is mixed urinary incontinence?

A

The complaint of involuntary leakage of urine associated with urgency and also with excretion, effort, sneezing or coughing

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6
Q

What is overflow incontinence (chronic urinary retention)?

A

The involuntary release of urine when bladder becomes overly full due to a weak bladder muscle or blockage

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7
Q

Causes of overflow incontinence

A
  • anticholinergic meds
  • fibroids
  • pelvic tumours
  • neurological conditions e.g. MS, diabetic neuropathy
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8
Q

What is over active bladder?

A

A frequent + sudden urge to urinate that may be difficult to control
Detrusor muscle contracts when it shouldn’t be

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9
Q

What is functional incontinence?

A

when a person is usually aware of the need to urinate, but for one or more physical or mental reasons they are unable to get to a toilet
often due to cognitive impairment or behavioural problems

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10
Q

Prevalence of urinary incontinence with age

A

Urgency incontinence (most)
Mixed incontinence
Stress (least)

Gradual increase with age with peaks after child birthing age + menopause in women+ older age

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11
Q

Risk factors of incontinence

A
  • pregnancy
  • pelvic surgery
  • race
  • anatomical or neurological abnormalities
  • menopause
  • increased inta-abdominal pressure
  • UTI
  • increasing age
  • obesity
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12
Q

Classifications of lower urinary tract symptoms

A

Storage
Voiding
Post micturition

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13
Q

List lower urinary tract storage symptoms

A
  • increased frequency
  • urgency
  • nocturia
  • incontinence
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14
Q

List lower urinary tract voiding symptoms

A
  • slow stream
  • spitting or spraying
  • intermittency
  • hesitancy
  • straining
  • terminal dribble
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15
Q

List lower urinary tract post micturition symptoms

A
  • post-micturition dribble
  • feeling of incomplete emptying
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16
Q

Why does menopause promote incontinence?

A
  • less oestrogen
  • oestrogen helps strengthen pelvic floor muscles > loss of tone in menopause
  • urethra passes through pelvic floor
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17
Q

How much volume is polyuria?

A

More than 3L a day

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18
Q

Difference between increased frequency of urination and polyuria

A
  • Polyuria is excreting > 3L per day
  • Increased frequency is a normal volume but need the toilet more times.

NOT THE SAME THING

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19
Q

Specific history questions to determine the type of urinary incontience

A
  • fluid intake (particularly tea + coffee)
  • previous pelvic surgery
  • history of large babies
  • how long symptoms have occurred for
  • symptoms of uterovaginal prolapse
    + faecal incontinence (relates to menopause)
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20
Q

If urinary incontinence is suspected to be due to neurological damage, what dermatomes need to be examined?

A

S2,3+4
‘S2,3,4 keeps the wee and poo off the floor’

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21
Q

Investigations of urinary incontinence

A
  • urine dipstick: MANDATORY - UTI, haematuria, proteinuria, glucosuria
  • midstream urine test
  • frequency volume chart
  • bladder diary >3 days
  • post micturition residual volume/bladder scan - catheterise (voiding dysfunction)
  • urodynamic tests
  • prostate assessment in men
  • external genitalia review
22
Q

What is assessed in an external genitalia exam for UI investigations?

A
  • pelvic tone
  • pelvic organ prolapse
  • atrophic vaginitis
  • urethral diverticulum
  • pelvic masses
23
Q

Outline urodynamic tests in assessing urinary incontinence

A

A catheter is inserted into the bladder + rectum. These two catheters measure pressures in both areas to compare. The bladder is filled with liquid + these are taken:
- cystometry: measures detrusor muscle contraction + pressure
- uroflowmetry: measures flow rate
- leak point pressure: the point at which the bladder pressure causes urine leakage (assesses SUI)
- post-void residual bladder volume
- video urodynamic testing

24
Q

General + conservative management of urinary incontinence

A
  • depends on symptoms + degree of bother to patient
  • modify fluid intake
  • weight loss
  • stop smoking
  • decrease caffeine intake > decaf coffee/tea (UUI)
  • avoid constipation
  • timed voiding
25
Q

Management of stress urinary incontinence

A
  • pelvic floor muscle training (8 contractions 3x a day for 3 months)
  • duloxetine: combined noradrenaline + serotonin uptake inhibitor > increased sphincter activity (alternative to surgery, not first line treatment)
26
Q

What is the next step for patients with urinary incontinence who have failed conservative or medical management?

A
  • indwelling catheter (urethral or suprapubic)
  • sheath device (condom catheter)
  • incontinence pads
27
Q

Surgical management of stress urinary incontinence in women

A

permanent:
- open retropubic suspension procedure
- classical autologous sling procedures
- low-tension vaginal tapes

temporary: if further pregnancies are planned
- intramural bulking agent

28
Q

Surgical management of stress urinary incontinence in men

A

Artificial urinary sphincter
Male sling procedure

29
Q

Management of urgency urinary incontinence

A

Bladder training: schedule of voiding
- void every hour during day
- must wait or leak in between
- intervals increased by 15-30 mins each week until interval of 2-3 hours reached
- over 6 weeks

30
Q

Pharmacological management of urgency urinary incontinence

A
  • anticholinergics: act on muscarinic receptors M2,3
    (side effects due to M receptors at other sides) - avoid in older people
  • B3 adrenoceptor agonist: increases bladders capacity to store urine mirabegron
  • butolism toxin
31
Q

Why are should you avoid oxybutynin + anticholinergics in older people?

A

can cause postural hypotension > increased risk of falls

32
Q

Contraindications of mirabegron

A

uncontrolled hypertension - BP must be monitored regularly during treatment

33
Q

Surgical management of urgency urinary incontinence

A
  • sacral nerve modulation
  • botulinum toxin type A
  • augmentation cystoplasty
  • urinary diversion
34
Q

What is botulism toxin?
What is it used for?

A
  • intravescial injection
  • inhibits release of Ach at pre-synaptic neuromuscular junction > targeted flaccid paralysis
  • used in urgency urinary incontinence after other pharmaceuticals
35
Q

What is enuresis?

A

Involuntary urination
(Particularly children at night - bed wetting)

36
Q

Define bed wetting

A

Involuntary wetting during sleep at least 2x a week in children > 5 with no CNS defects

37
Q

Managment of primary enuresis without daytime symptoms

A
  • normally in primary care
  • reassurance
  • positive reward system
  • desmopressin overnight to supplement ADH
38
Q

What nerve maintains voluntary continence?

A

Pudendal nerve

39
Q

Management of primary enuresis with daytime symptoms

A
  • normally caused by disorder of lower urinary tract
  • refer to secondary care
40
Q

Managment of secondary enuresis

A

Treat underlying cause
e.g. UTIs, constipation, diabetes, psychological problems

41
Q

What nerve matures during potty training?

A

Pudendal nerve

42
Q

What hormone is released during the night to prevent bed wetting?

A

ADH

43
Q

Compare the specific management of stress and urgency urinary incontinence including potential drugs given

A

Stress:
- pelvic floor muscle training
- duloxetine

Urgency:
- bladder training
- anticholinergics
- B3 adrenoceptor agonist
- botulism toxin

44
Q

What drugs can be given to help with urgency urinary incontinence?
How do they help?

A
  • anticholinergics: ACh acts on M3 receptors as part of the parasympathetic stimulation of detrusor muscle of the bladder which causes contraction | anticholinergics oppose this action
  • B3 adrenoceptor agonists: NA acts on B3 receptors as part of the sympathetic inhibition of detrusor muscle which prevents contraction| B3 agonists promote this action (relaxes bladder + increases bladders capacity to store urine)
45
Q

What is duloxetine used for?
How does it work?

A
  • stress urinary incontinence
  • combined noradrenaline + serotonin uptake inhibitor > increased sphincter activity
  • alternative to surgery, not first line treatment
46
Q

What antimuscarinic is given in urgency urinary incontinence?

A

Oxybutynin

47
Q

What is normal functional bladder capacity?

A

400-500ml

48
Q

What is the mechanism of action of oxybutynin?

A

antimuscarinic
Blocks M3 receptors in bladder > stops Ach from binding > inhibits contraction of bladder

49
Q

Why can dementia patients have urinary incontinence?

A
  • regulation of paracentral lobules to M centre lost
  • or functional incontinence
50
Q

Drugs used to treat overactive bladder

A
  • anti muscarinic: e.g. oxybutynin
  • B agonists: e.g. mirabegron
  • botulinum toxin injection

Urinary (24 decks)

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