URINARY INCONTINENCE Flashcards
Two main types of incontinence
Urgency
Stress
Urgency incontinence
Sudden immediate need to pass urine
difficult to delay
Stress incontinence
leakage on effort or exertion
- loss of pelvic floor support/and or damage to the urethral sphincter
Mixed incontinence
Urgency and stress
However one type tends to be predominant
Risk factors
Old age
Pregnancy + vaginal delivery
Obesity, smoking
Constipation
Family history
Medicines
What medication can predispose you to UI
Diuretics, alcohol, and caffeine
Non-drug treatment
modify fluid intake
weight loss if obese (30kg/m2)
reduce caffeine
Urgency incontinence treatment
First Line: Bladder training for at least 6 weeks
Second Line: Antimuscarinic (oxybutynin or tolterodine or darifenacin)
Third Line: Mirabegron
Stress incontinence treatment
Pelvic floor muscle training for at least 3 months (at least 8 contractions tds)
Surgery or Duloxetine
Mixed incontinence treatment
Bladder training (>6 weeks) + pelvic floor muscle training (>3 months)
Treat pharmacologically in accordance to dominating type
urine dipstick
should be performed in all women presenting with incontinence
test for active infection or haematuria, and analysed along with the patients symptoms.
How often should treatment be reviewed?
Treatment should be reviewed after 4 weeks, or sooner if required.
If treatment is effective review the woman again at 12 weeks, then annually thereafter, or every 6 months if the woman is over 75 years of age
Antimuscarinics examples
Festerodine
Solifenacin
Trospium
Oxybutynin
Tolterodine
Antimuscarinic - MoA
Relax urinary smooth muscle.
Reduce symptoms of urgency and urge incontinence.
Increases bladder capacity
Beta-3 agonist - examples
Mirabegron - relaxes urinary smooth muscle via selective b3 receptor stimulation.
