Urinary incontinence Flashcards
Define what urinary incontinence is
The complaint of any involuntary leakage of urine
What are the 4 types of urethral urinary incontinence ?
- Urge
- Stress
- Mixed
- Overflow
What are 2 other examples of urinary incontinence other than urethral ones ?
Due to extraurethral route - e.g. ectopic ureter draining straight into the urethra or a fistula
Describe the symptoms/signs of overflow incontinence
- It is due to bladder flow obstruction causing urine to build up resulting in chronic retention then eventually the person is incontinent
- Large palpable bladder
- Usually don’t feel that they are incontinent
- Often wet at night
Who is usually affected by overflow incontience ?
Men - as can be caused commonly by enlargement of the prostate
Describe the signs/symptoms of urge incontinence
- You have an urgent desire to pass urine and sometimes urine leaks before you have time to get to the toilet
- Sometimes provoked by things e.g. putting the key in the door, sound of running water etc
What is urge incontinence often due to ?
Detrusor overactivity - which is essentially due to overstimulation by nerves
What are some of the causes of detrusor overactivity ?
- Tumours or bladder stones causing irritation in the bladder
- Pelvic surgery or fractures causing damage to the parasympathetic supplying the bladder
- Paraplegia - loss of central inhibition
- Destruction of S2,3 segment
- Infection
How is detrusor overactivity diagnosed ?
By Cystomethogram – Urodynamics
What is detrusor overactivity characterised by on urodynamics?
Rise in detrusor pressure causing rise in intravesicular pressure with no increase in abdominal pressure
What are the signs/symptoms of stress incontinence ?
- Urine leaks during increased intra abdominal pressure, without a detrusor contraction
- e.g. when coughing can get leaks, can be due to weak pelvic floor muscle due to pregnancy
What is the most common type of urinary incontinence ?
Stress incontinence
How is stress incontinence diagnosed ?
Urodynamic studies
What are the characteristics of stress incontinence on urodynamic studies ?
Will show increased abdominal pressure corresponding to increased filling without increased detrusor pressure
What is the treatment of overflow incontinence ?
- Catheterise to relieve the urine
- Treat the obstruction
- Rehabilitate the bladder
- Assess renal function - as the blockage can cause backflow leading to hydronephrosis (diagnose with US)
