Urinary incontinence Flashcards
What is the definition of urinary incontinence?
Involuntary leakage of urine
True or False
Urinary incontinence is more common in females
True
Describe the storage phase of the bladder, in terms of pressures exerted
Intravesical pressure is less than urethral pressure
Where does the pressure come from in the voiding phase of micturition?
Detrusor muscle of bladder
What is urodynamics?
Study of the pressures of the bladder/abdomen using transducers
What effect does coughing have on intravesical pressure?
Increases pressure
What effect does coughing have on abdominal pressure?
Increases pressure
Which nerves supply the pudendal nerve?
S2, 3 and 4
What causes overflow incontinence?
Bladder overflow due to obstruction
What can be seen clinically in a patient with overflow incontinence?
Large palpable bladder
What is urge incontinence?
Involuntary passing of small volumes frequently and urgently
What might bring on urge incontinence?
Sound of running water
Coughing
Laughing
Jumping
What is detrusor overactivity?
Detrusor contractions during states of inhibition of voiding.
How is detrusor overactivity diagnosed?
Urodynamic therapy
What might cause afferent overstimulation?
Irritation in bladder e.g. stone
What would happen if S2 and 3 were destroyed?
Bladder would have no tone
What is stress incontinence?
Stress has been put on pelvic floor or urethra over time which causes urine leakage due to increased abdominal pressure
What can cause stress incontinence?
Childbirth
What is the treatment for overflow urinary incontinence?
Assess renal function
Catheterise patient
Teach intermittent self-catheterisation
How is urge incontinence treated conservatively?
Diet changes
Time bladder emptying
What pharmacological treatment can be given for urge incontinence?
Antimuscarinics e.g. oxybutinin or tolterodine
Beta 3 adrenergics e.g. mirabegron
What is enterocystoplasty?
Surgical solution to urge incontinence where the bladder is voided permanently through a catheter
What is the treatment for stress incontinence?
Wt loss
Smoking cessation
Pelvic floor exercises
What is an ectopic ureter?
Additional ureter which joins the urethra below the sphincter.
Congenital
What are the risk factors for urinary incontinence?
Obese
Pregnancy
Vaginal delivery
Why should an examination be undertaken in women with incontinence?
To check for prolapse and assess pelvic floor strength
What does the management of urinary incontinence involve after having taken a history and examination?
Urine dipstick
Bladder diary for 3 days
How many times a day is it normal to pass urine?
4-8
How much urine should be in each normal void?
300-600ml
What does bladder training involve?
Training bladder to void every hour, then increasing that interval.
When should urgent referral to secondary care be made?
Visible haematuria
Recurrent UTI with microscopic haematuria
microscopic haematuria if over 50
When should routine referral to secondary care be made?
Visible prolapse that is symptomatic
Palpable bladder post-void
What incontinence is male specific?
Post-micturition dribble
Post-prostectomy incontience
What can be advised in post-micturition dribble?
Urethral milking.
Massaging the bulbar urethra (at perineum) to remove excess urine
What do 5-alpha reductase inhibitors do?
Stops conversion from testosterone to dihydrotestosterone so prevents BPH
When should men be referred with incontinence?
If painful
Recurrent infections
Haematuria
What drugs may cause incontinence?
Calcium CB
Opiates
