Urinary incontinence Flashcards
Define urinary incontinence?
Any involuntary leakage of urine
Why is important you ask specifically about incontinence?
Some people will be embarrassed and so hide it.
What ratio of women are affected? What ratio of men are affected?
Women: 1:3
Men: 1:10
With regard to urethral urinary incontinence, what are the four major causes?
Overflow incontinence
Urge incontinence
Stress incontinence
Mixed incontinence
In the storage phase of micturition, intravesicular pressure is less/more than urethral pressure
Less than; urine is therefore retained.
Abdominal pressure affects intravesicular pressure - true/false
True - increase intra-abdominal pressure (e.g. cough) and the intravesicular pressure goes up.
Detrusor pressure in the storage phase should be approximately __
0
Detrusor contracts during the voiding to increase intravesicular pressure and intra-abdominal pressure above the urethral and atmospheric pressure - true/false
False - only affects intravesicular pressure. No effect on intra-abdominal; anterolateral control this and can be consciously contracted but do not contract during the reflex.
When intravesicular pressure is higher than atmospheric, what will happen
Urine is much more likely to flow
What are the components of the micturition reflex?
Brain
Spinal cord (S2-4)
Bladder/sphincters
Describe the micturition reflex
Afferent fibres would sense stretch and relay it to the spinal system and the efferent fibres will stimulate contraction and relaxation of the sphincters.
How do we control micturition?
Cortical centre of the brain sends inhibitory signals to override the reflex.
What nerves are involved in micturition?
Parasympathetic (pelvic) and pudendal nerves - all from S2-S4
What is overflow incontinence?
Bladder outflow obstruction, huge palpable bladder, chronic urine retention. Insensible incontinence with no warning.
How is overflow incontinence often noticed?
it is often noticed because of wet beds?
urge incontinence is part of _____ syndrome.
Urge syndrome.
What is urge incontinence?
Frequent, small voided volumes. Can be provoked by many things e.g. key in door, running water, standing up, coughing, laughing etc.
Urge incontinence doesn’t get wet at night - true/false
False - it can
Some patients will reach the toilet on time almost everytime with urge incontinence - true/false
True
What characterises urge incontinence?
Overactivity of detrusor; contractions while trying to inhibit detrusor either consciously or subconsciously.
New onset urge incontinence is a red flag - true/false
true; could be bladder irritation.
Give a few causes of urge incontinence
Excess central facilitation brought on by anxiety
paraplegia giving loss of inhibitory control
S2-S4 very vulnerable to spinal injury
Pelvic surgery or fracture cause parasympathetic nerves
idiopathic
Stress incontinence is due to anxiety and emotional stress - true/false
false - abdominal pressure stress
Define stress incontinence
Incontinence due to increased abdominal pressure without detrusor contraction.
What causes stress incontinence?
Damage to pelvic floor or urethra - commonly thanks to childbirth.
What is a good test of stress incontinence?
When the patient coughs, do they leak? If yes, they probably have stress incontinence
What should make you think that an abdominal mass is a full bladder?
Painless, palpable, midline suprapubic region, arising from the pelvis, you can’t get below it and it is dull to percussion
if they are female and appear to have a full bladder, what else should you think?
Pregnancy - ask about missed periods.
How should you treat an overflow incontinence?
Assess renal function and relieve the obstruction using a catheter. Rehabilitate bladder and teach them intermittent self-catherisation to help relieve the bladder entirely each time.
Why is caffeine important in urge incontinence?
Causes diuresis and makes urge incontinence much worse; (Decaf anyone?)
What non-pharmacological treatment can you use for urge incontinence?
teach them to understand the volumes they’re passing and retrain their bladders
Surgery (absolutely the last option!)
What pharmacological therapy is there for urge incontinence?
Antimuscarinics (oxybutynin and tolteridine)
Beta-three adrenerics (mirabegron)
Botox (unlicensed but can be used)
Neuromodulation
Stress incontinence first line treatment is…
Weight loss
Smoking cessation
Pelvic floor exercises physiotherapy
What drug has a slight pharmacological action in stress incontinence?
Duloxetine - Serotonin 5HT inhibitor and noradrenaline reuptake inhibitor.
What non-pharmacological treatment might you consider for stress incontinence?
Surgical procedures such as colposuspension - replaced largely by minimally invasive tape procedures
Mixed incontinence is treated as ….
A mixture of treatments for stress and urge incontinence
Incontinence in the elderly has many factors - true/false
True
name some of the factors contributing to incontinence in the elderly
Immobility Dementia Drugs (e.g. diuretics and sedatives) Obstruction and overflow Neuropathy Pelvic floor weakness
Ectopic ureter is a common cause of incontinence - true/false
False - very rare congenital issue
How does ectopic ureter cause incontinence?
Attaches below the bladder to urethra and so causes continuous incontinence.
Fistula as a cause of incontinence is very important in what scenario?
Developing countries where access to gynaecology is not readily available. Very uncommon in now in developed countries.
