Urinary incontinence Flashcards
Define incontinence
involuntary loss of urine or stool in sufficient amount or frequency to constitute a social and/or health problem
Is urinary incontinence a part of normal aging?
no
What are the sections of the male urethra?
prostatic urethra
membranous urethra
bulbous urethra
penile urethra
Name some types of incontinence
urgency incontinence
stress incontinence
overflow incontinence/nocturnal enuresis
continuous incontinence
post-micturition dribbling
Define urge incontinence
involuntary leakage of urine accompanied or immediately preceded by urgency
What is urinary urgency?
sudden compelling desire to void which is difficult to defer for fear of leakage
Define stress urinary incontinence
involuntary leakage on effort, exertion, sneezing or coughing
What causes stress incontinence?
damage to continence mechanism
men = TURP, RRP, trauma
women = ligament, fascia laxity
What causes continuous incontinence?
sphincter incompetence
fistula
Describe giggle incontinence
young women/children
involuntary loss of urine during laughing
What causes post void dribbling?
urine can pool in bulbous urethra
Risk factors for incontinence
female
older age
parity
pregnancy
obesity
(in men - prostatectomy, bladder outlet obstruction)
Name some storage symptoms that should be asked in an incontinence history
frequency day and night
longest postpone
urgency
leakage
Name some voiding symptoms that should be asked in an incontinence history
hesitancy
poor stream
incomplete emptying
Incontinence red flags
history of UTI
frank haematuria
pain
pelvic mass
pelvic radiation
previous surgery
symptomatic prolapse
suspected fistula
What investigations should be done in urinary incontinence?
dipstick
voiding diary
flow rate and post void residual
questionnaires
urodynamics
Urge incontinence due to detrusor overactivity treatment
conservative - fluid and dietary advice, bladder retraining
antimuscarinics
S3 neuromodulation
surgery - botox, S3 implant, clam cystoplasty
How do antimuscarinic drugs work in urge incontinence?
inhibit muscarinic receptors in bladder
decreases involuntary detrusor contractions and increases bladder capacity
Name some antimuscarinic drugs used in urge incontinence
oxybutynin
tolterodine
trospium
Contraindications to anticholinergics
uncontrolled narrow angle glaucoma
myasthenia gravis
bowel disorders eg. UC, bowel obstruction
Side effects of antimuscarinic drugs
dry mouth
constipation
raised IOP
blurred vision
paralysis of accommodation
drowsiness
confusion
tachycardia
Mirabegron MOA
selective B3 adrenoceptor agonist
relaxes detrusor muscle during storage phase
improves storage capacity and decreases voiding frequency
Treatment for female stress urinary incontinence
conservative - weight loss, pfmt (pelvic floor muscle training)
drugs - duloxetine
surgery - injectables, sling surgery, colposuspension
Male stress urinary incontinence treatment
pelvic floor muscle training
injectables
male sling
artificial urinary sphincter
