Urinary Incontinence Flashcards
What is meant by urinary incontinence
Involuntary leakage of urine
What are the different types of urinary incontinence
Urgency incontinence: sudden immediate need to pass urine that is difficult to delay. Due to bladder detrusor muscle becoming weaker
Stress incontinence: leakage on effort or exertion, or on sneezing or coughing
Mixed incontinence: urgency or stress, however one type tends to be predominant
What are the risk factors of urinary incontinence
Old age
Pregnancy and vaginal delivery
Obesity and smoking
Constipation
Family history
Medicines (diuretics, alcohol, and caffeine all increase the production and can exacerbate incontinence)
What is the treatment urinary incontinence without using drugs
Modify fluid intake
Weight loss if obese
Reduce caffeine and alcohol
What is the treatment for urgency urinary incontinence
First line: bladder training for at least 6 weeks
Second line: antimuscarinics (oxybutynin or tolerodine)
Third line: mirabegron
What is the treatment of stress urinary incontinence
Pelvic floor muscle training for at least 3 months
Surgery or duloxetine
What is the treatment of mixed urinary incontinence
Bladder training (> 6 weeks) + pelvic floor muscle tracing for at least 3+ months
Treat pharmacologically in accordance to the dominant type
What antimuscarinic drugs are used in urinary incontinence
Fesoterodine
Solifenacin
Trospium
Oxybutynin
Tolterodine
What is the adverse effects of using antimuscarinic drugs in the elderly
Constipation
Dry mouth
Flushing
Dizziness
Drowsiness
Tachycardia
What antimuscarinic drugs used in urinary incontinence contraindicated in
Angle-closure glaucoma
Gastro intestinal obstruction
What can antimuscarinic drugs do to a patient
Can affect the performance of skilled tasked eg driving as can make you drowsy
What is meant by nocturnal enuresis
Involuntary urination during sleep- common in children
What is the non-drug treatment
Advise on fluid intake, diet, toileting behaviour and use a reward system
If there is no response to advise (more than 1-2 bed wets per week)- enuresis alarm
- alarms <7 years given depending on maturity, motivation and understanding
- alarms have less relapse than drug treatment when discontinued
- review alarm after 4 weeks
- continue until a minimum if 2 weeks of interrupted dry night
If alarm treatment is unsuccessful: add in/ replace with desmopressin
- children under 5 should resolve without intervention*
What is the drug treatment for nocturnal enuresis
Children over 5: DESMOPRESSIN
-if alarm is undesirable
- when needing rapid results (to cover holidays)
- assess treatment after 4 weeks and continue for 3 months if patient is responding
- repeated courses should be withdrawn gradually at regular intervals
Specialist: desmopressin +/- antimuscarinic ( oxybutynin or tolterodine)
Not responding to all other treatments: imipramine
What is desmopressin
More potent and longer duration of action than vasopressin
No vasoconstrictor effect
Side effects includes:
Hyponatraemia (sodium is low)
Nausea
