Urinary Incontinence Flashcards
what is meant by urinary incontinence?
the complaint of any involuntary leakage of urine
what are the 4 main types of urethral urinary incontinence?
- overflow incontinence
- urge incontinence
- stress incontinence
- mixed incontinence
what are the 2 causes of extraurethral urinary incontinence?
- ectopic ureter
- fistula
during coughing, should the detrusor pressure change?
no, should stay the same
what causes overflow incontinence?
bladder outflow obstruction causing chronic retention
what might you notice of examination of someone with overflow incontinence?
huge palpable bladder
when do patients with overflow incontinence usually experience the incontinence?
during the night
what can overflow incontinence lead to?
renal impairment
what do people with urge incontinence experince?
urgency and frequency, small voided volumes. wetting the bed at night.
what are the common triggers for urgency?
- putting key in the door
- sound of running water
- standing up
- coughing, laughing
what can urge incontinence be due to?
detrusor overactivity
what would suggest detrusor overactivity?
bladder dysfunction characterised by detrusor contractions occuring during inhibition of voiding
how is detrusor overactivity diagnosed?
urodynamics
what could be causing urge incontinence if it is a new problem?
could be a bladder stone or tumour
when is there leaks in stress incontinence?
urine leaks during increased intra abdominal pressure, without detrusor contraction
what is stress incontinence usually due to?
damage to pelvic floor or urethral function eg in childbirth
treatment of overflow urinary incontinence?
- assess renal function
- treat the obstruction and catheterise to empty bladder
- rehabilitate the bladder
what is a patient with overflow incontinence taught to do?
intermittent self catheterisation
what should be avoided in urge incontinence?
caffeine
what drugs can be given in urge incontinence?
- antimuscarinics (eg oxybutynin, tolterodine)
- beta 3 adrenergic (mirabegron)
what can be inserted into the bladder to treat urge incontinence?
neuromodulation (pacemaker for the bladder)
what surgery can be performed in urge incontinence?
enterocystoplasty
conservative managment of stress incontinence?
- weight loss, stop smoking
- pelvic floor exercises - physio
drug treatments for stress incontinence?
duloxetine
what are the surgical corrections for stress incontinence?
- open procedures- colpsosuspension
- now more minimally invasive “tape” procedure is used
what is mixed incontinence a mix between?
urge and stress incontinence
what causes a vesico-vaginal fistula commonly in developing countries?
prolonged obstructed labour
what does a frequency volume chart record?
the volumes voided as well as the time of each micturation, day and night for atleast 24 hours
