Urinary Incontinence Flashcards
What are the 4 types of urinary incontinence?
1) stress incontinence
2) urge incontinence
3) overflow incontinence
4) functional incontinence
What is stress incontinence?
where urine leaks from the bladder due to higher pressures than the pelvic muscles are NOT able to contain
What is the main cause of stress incontinence?
weakness or damage to the pelvic floor muscles (e.g. multiple pregnancies)
Give 3 instances where stress incontinence is more likely to occur:
1) coughing
2) laughing
3) straining
Give 3 conservative measures used to manage stress incontinence:
1) pelvic floor strengthening exercises
2) review of fluid intake
3) weight loss (puts less stress on the pelvic floor)
If conservative measures are unsuccessful in treating stress incontinence, what should be considered?
Surgery
What are the surgical options for stress incontinence?
- mid-urethral tape procedures (still recommended by NICE but only after discussing risks and benefits)
- intramural bulking agent injections
- colposuspension
What may be offered to women who decline surgical procedures for stress incontinence?
Duloxetine
mechanism of action: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced contraction
What is urge incontinence?
overactive bladder - the bladder comes irritable causing the patient feel that they urgently need to empty it when it is not actually full
Give 3 symptoms of urge incontinence:
1) frequency
2) urgency
3) nocturia
Along with the conservative measures used to treat stress incontinence, name 2 other methods used to treat urge incontinence:
1) avoiding bladder irritants such as dehydration and caffeine
2) bladder training - increasing the time from feeling the urge to pass urine to actual micturation
Name two anti-micturinic drugs used to treat urge incontinence:
1) oxybutynin
2) tolterodine
Give 4 side effects of anti-micturinic drugs:
1) dry mouth
2) dry eyes
3) constipation
4) confusion
(most patients stop taking them after three months due to the side effects)
What is overflow incontinence?
incontinence due an obstruction causing an overfilled bladder e.g. prostate enlargement or constipation
What is a common treatment for overflow incontinence?
catherisation
What is functional incontinence?
Caused by problems that prevent you from getting to the bathroom in time to avoid an accident
what is the epidemiology of urinary incontinence?
most common in elderly females
what are the risk factors for urinary incontinence?
- increasing age
- previous pregnancy + childbirth
- obesity
- hysterectomy
- FH
what are the investigations for urinary incontinence?
- rule out reversible causes of incontinence
- physical examination (exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles)
- bladder diary for 3 days
- urinalysis
- urodynamic studies (cystometry and cystogram)
why must you perform a physical examination of the vagina when investigating urinary incontinence?
- exclude pelvic organ prolapse
- assess ability to initiate voluntary contraction of pelvic floor muscles
What is mixed incontinence?
A mix between urge and stress and incontinence
Give 3 examples of causes for functional incontinence:
- Dementia
- Sedating medication
- Injury/Illness resulting in decreased ambulation
What drug is recommended to be avoided in frail elderly women?
Immediate release oxybutynin
mirabegron (a beta-3 agonist) may be useful if there is concern about anticholinergic side-effects in frail elderly patients
