Urinary Incontinence Flashcards
What is the effect of sympathetic and parasympathetic system on detrusor muscle and sphincter muscle?
Sympathetic - relaxes detrusor muscle, contracts sphincter muscle
Parasympathetic - contracts detrusor muscle, relaxes sphincter muscle
How is urge incontinence like?
The main problem is detrusor muscle being over-active; sphincter is not so much affected
“Involuntary leakage accompanied by or immediately preceded by urgency”
They want to go to the toilet but before they get there they have an incontinent accident
How is stress incontinence like?
Detrusor muscle is fine, but external sphincter is not functioning normally
“leakage on effort or exertion, sneezing or coughing”
Urine leaks during increased intra-abdominal pressure, like when sneezing or coughing, withOUT a detrusor contraction
What are extraurethral routes of urinary incontinence?
Ecotopic ureter which may open directly into urethra
Fistula might form between vagina and bladder
How does overactive bladder syndrome present?
Urgency, with or without incontinence, usually with frequency and nocturia
What are causes of urge incontinence?
Most likely due to overactive detrusor muscle;
Some times due to infection/inflammation/stone that irritates the bladder
What are causes of stress incontinence?
Bladder neck or urethral hypermobility (in females, when the angle between bladder and urethra is affected, that can lead to incontinence)
Neuromuscular defects causing intrinsic sphincter deficiency
What is overflow incontinence?
Bladder outflow obstruction leading to very high volume in the bladder - usually painless palpable mass
Chronic retention
Dripping
Risk factors of UI?
Female > Male (Pelvic floor become weaker after estrogen tails off)
Caucasian > Afro-caribbean
Neuro disorders eg.spinal cord injury, stroke, MS, PD
Childbirth
Surgery in the region
Radical pelvic radiotherapy (eg radiation cystitis)
Diabetes - peripheral neuropathy
Promoting factors of UI?
Smoking - causing cough/irritation of bladder
Obesity - weakness of pelvic floor muscle
Infection - UTI (cystitis)
Increased fluid intake - intake/output diary
Poor nutrition
Ageing
Cognitive deficit
Poor mobility - weakness of muscle/constipation
Oestrogen deficiency
Caffeine also causes irritation of bladder
Red flags in urinary incontinence?
Pain (indicate imaging), haematuria (rule out cancer), recurrent UTI, significant voiding/obstructive Sx, Hx of pelvic surgery/radiotherapy
What are basic investigations for UI?
Bladder diary (frequency/volume chart for both input and output)
Urinalysis +/- culture
Flow rate and post-void residue
Pad testing
What does cystometry do?
It measures intra-vesical and intra-abdominal pressure, as well as vesical volume
Detrusor pressure is calculated by subtracting intra-abdominal pressure from intra-vesical pressure
Management for urge UI?
For Urge incontinence:
Avoid caffeine
Biofeedback
Bladder retraining
Meds: Antimuscarinics (eg oxybutynin, tolterodine); beta 3 adrenergics (eg mirabegron)
Botulinum toxin injection into bladder (anti-cholinergic)
Neuromodulation (“pacemaker” for bladder)
Surgery: increase bladder capacity when needed
Management for stress UI?
Weight loss
Stop smoking
Pelvic floor exercise
Meds (not much role) - can give duloxetine to improve sphincter activity
Surgery:
various
