Urinary incontinence Flashcards
Definition
Involuntary leakage of urine due to inability to control the bladder.
Urination physiology
When stretch receptors in the bladder wall sense the bladder is half full they send impulses to the sacral spine: S2 + S3 and brain pons: pontine storage centre and pontine micturition centre.
S2-S3 micturition reflex:
= increased parasympathetic stimulation and decreased sympathetic stimulation
= detrustor muscle contract and internal sphincter to relax
= decreases motor nerve stimulation allowing external sphincter to relax
Pons - voluntarily control of urination:
= pontine storage centre overrides the micturition reflex when you want to delay urination
= pontine micturition centre allows for the micturition reflex to take place when you want urination to take place.
Types of urinary incontinence
- Stress incontinence
- Urge incontinence
- Mixed incontinence
- Overflow incontinence
- Functional incontinence
Stress incontinence definition and causes
Involuntary leakage during activities that increase abdominal pressure e.g.
- Coughing
- Sneezing
- Exercise
Caused by weakened pelvic floor muscles or an impaired urethral sphincter
Urge incontinence
Involuntary leakage accompanied by a strong, sudden need to urinate, usually due to overactive bladder muscle contraction.
Triggers:
- Neurological disorders
- Infections
- Bladder irritants
Mixed incontinence
Combination of two or more types of incontinence.
Stress and urge incontinence MC combination.
Px may experience clinical features of both
Over flow incontinence
(You keep getting this wrong. CLUE: OVERFLOW = OBSTRUCTION)
- Involuntary leakage caused by an inability to completely empty the bladder, often due to an obstruction or poor bladder muscle function
- Characteristic signs: weaker intermittent stream or hesitancy
Functional incontinence
Inability to reach the toilet in time due to physical or cognitive impairments, despite normal bladder function
Epidemiology
- Age
- Female
- Previous pregnancies and deliveries: esp linked to stress incontinence due to weakness of the pelvic floor
- Obesity
- Menopause
- Neurological disorders
- Urinary tract infections
- Certain medications: diuretics, doxazosin and oxycodone
Signs
- Perianal skin irritation
- Damp underwear
Symptoms
- Involuntary urine leakage: suddenly is linked to urge; with increases in intra-abdominal pressure is linked to stress
- Urgency (mainly urge)
- Increased frequency
Investigations
Thorough history
Urinalysis:
- Infection
- Haematuria
- Glucose
* Above may contribute to incontinence *
Bladder diary: document fluid intake, voiding frequency, and episodes of incontinence for 3-7 days
Post-void residual urine (PVR): Assess bladder emptying using USS or catheterization
Urodynamic testing: Measures bladder pressure and function. usually reserved for complex cases or before surgery.
Criteria fro 2 week wait for bladder cancer
- 45 + with unexplained visible haematuria without UTI, or visible haematuria that is persistent or recurrent after successful treatment of UTI
- 60 + with unexplained non-visible haematuria and dysuria or a raised white cell count on a blood test
Treatment stress incontinence
= Manage reversible risk factors: weight loss
= Life style mods:
- Smoking cessation
- Fluid management
- Avoidance of bladder irritants such as caffeine
FIRST LINE = Pelvic floor muscle training: 3 months kegal exercises
Second line = Duloxetine (SNRI)
Third line = Surgery
Urge incontinence treatment
- Bladder training: scheduled voiding with gradually increasing intervals between voids to improve bladder control
- Antimuscarinitic drugs e.g OXYBUTYNIN = decreases bladder contractions and increases bladder capacity
- Mirabegron = beta-3 adrenergic agonist that relaxes the bladder muscles and increases its capacity, used for overactive bladder and urge incontinence
- Specialist referral: secondary care treatment options:
= injection of botulinum toxin type A into the bladder wall,
= percutaneous sacral
= nerve stimulation,
= augmentation cystoplasty,
= urinary diversion
