Urinary incontinence Flashcards
Define urge incontinence.
Involuntary leakage of urine which is accompanied or preceded by an “urge” to pass urine.
What is overactive bladder syndrome?
Increased frequency + nocturia, not necessarily with incontinence
If incontinent; classed as urge incontinence
What is stress incontinence?
involuntary leakage of small amounts of urine when there is increased intra-abdominal pressure e.g. coughing, laughing
What is mixed incontinence?
Urge + stress incontinence
What causes overflow incontinence?
Detrusor under activity or bladder outlet obstruction causing urinary retention + leakage of urine
What causes continuous incontinence?
severe mixed incontinence
or
due to a fistula e.g. vesicovaginal fistula- dribbling
What causes urge incontinence?
Detrusor overactivity
Urge to urinate is quickly followed by uncontrollable leakage ranging from a few drops to complete bladder emptying
What is functional incontinence? What causes it?
Comorbid physical conditions impair ability to get to a bathroom in time
Causes:
dementia
Sedating medication
Injury/ illness resulting in decreased ambulation
What are 4 risk factors of urge incontinence?
Age
Obesity
FH
Diabetes
What are 5 risk factors of stress incontinence?
Age
Traumatic delivery (Forceps)
Smoking
Obesity
Previous pelvic surgery
What 4 investigations should be performed for urinary incontinence?
Bladder diaries for min. 3 days
Vaginal examination to exclude pelvic organ prolapse + ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
Urine dipstick + culture
Urodynamic studies
What investigation should be performed if vesicovaginal fistula is suspected?
Urinary dye studies
What causes stress incontinence?
Pelvic floor weakness/ intrinsic sphincter deficiency
What conservative advice can be given to those with urinary incontinence?
Avoid caffeinated drinks
Avoid drinking excessive/ reduced amounts of fluids daily
Weight loss if BMI >30
Smoking cessation (stress incontinence)
What is the firstline management for stress incontinence?
Pelvic floor muscle training
At least 8 contractions performed 3x per day for min 3/12
What is the medical management for stress incontinence?
Duloxetine: enhances sphincter contraction
r/v in 2-4w if unsuitable for surgery/ prefer pharmacological
What is the surgical management for stress incontinence?
Colposuspension: lift neck of bladder + fix to Coopers ligaments
Autologous rectus fascial sling or Retropubic mid-urethral mesh sling: elevate urethra
Intramural urethral bulking agents: inject bulking agent around urethra
What is the first line treatment for urge incontinence?
Bladder retraining for 6w
Gradually increase intervals between voiding
What is the medical management for urge incontinence?
Antimuscarinics:
Oxybutinin, Tolterodine, Darifenacin
Which drug should be avoided in frail older women with urge incontinence? What should be used instead?
Avoid Oxybutinin due to anticholinergic SE
Use Mirabegron
What surgical procedures can be used for urge incontinence?
Botox injection
Percutaneous tibial nerve stimulation
Sacral nerve stimulation
What is the risk associated with botox infections for urge incontinence?
Temporary urinary retention
Need to be willing to self catheterise
