Urinary incontinence Flashcards
Which group is urinary incontinence most common in
elderly females
What are some risk factors
advancing age
previous pregnancy and childbirth high BMI
hysterectomy
family history
What is overactive bladder/urge incontinence
due to detrusor overactivity
urge to urinate quickly followed by uncontrollable leakage
What is stress incontinence
leaking small amounts of urine when coughing or laughing
What is mixed incontinence
when you have multiple
What is overflow incontinence
due to bladder outlet obstruction – eg due to prostate enlargement
bladder still palpable after urination
What is functional incontinence
comorbid physical conditions impair patients ability to get to a bathroom in time
causes include dementia, sedating medication and injury/illness resulting in decreased ambulation
What is urge incontinence management
- bladder retraining
- bladder stabilising drugs
What investigations are required
bladder diary should be completed for minimum of 3 days
vaginal examination
urine dipstick and culture
urodynamic studies
What bladder stabilising drugs can be used for urge incontinence
antimuscarinics are first line
- Oxybutynin- should be avoided in frail older women
-Tolterodine
-Darifenacin
Mirabegron - beta 3 agonist can be useful if concerned about anticholinergic side effects
What is the management for stress incontinence
pelvic floor muscle training
- at least contractions performed 3 times a day for min 3 months
-surgical procedures
mid-urethral slings
What can be offered to women with stress incontinence if they decline surgery
Duloxetine
- combined noradrenaline and serotonin reuptake inhibitor
how does duloxetine work
increased synaptic concentration of noradrenaline and serotonin within pudendal nerve – increased stimulation of urethral striated muscles within sphincter – enhanced contraction
