Urinary Incontinence Flashcards
Understand the incidence of urinary incontinence
- Stress urinary incontinence - almost 50%
- Mixed and urge urinary incontinence - ~25% each
Describe the prevalence with age of urinary incontinence
Increases with age
Define urinary incontinence
The complaint of any involuntary leakage of urine
Describe lower motor neuron lesions causing urinary incontinence
- Can be due to diabetes, tumour (cauda equina tumour), B12 deficiency
- Parasympathetic input to the bladder prevented
- Causes incontinence
Describe upper motor neuron lesions causing urinary incontinence
- Takes away inhibition to parasympathetic nerves
- High pressure detrusor contractions with poor coordination of sphincters
- Detrusor sphincter dyssynergia - bladder has to work harder against unresponsive sphincter
- Overactive micturition
Differentiate between stress and urge incontinence
- Stress urinary incontinence (SUI) - the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing
- Urge urinary incontinence (UUI) - the complaint of involuntary leakage of urine accompanied by or immediately proceeded by urgency
What are risk factors of urinary incontinence
- Predisposing - race, family history
- Promoting - menopause, drugs, UTI, age, obesity
- Pregnancy, pelvic prolapse, pelvic surgery
State the initial investigation of urinary incontinence
- Urine dipstick - UTI, haematuria, proteinuria, glucosuria
- Mandatory for every patient
- Frequency-volume chart
- Bladder diary (≥3 days)
- Post-micturition residual volume - in patients with voiding dysfunction
What are some lifestyle interventions to reduce urinary incontinence
- Modify fluid intake
- Weight loss
- Stop smoking
- Decrease caffeine intake
- Avoid constipation
- Timed voiding - fixed schedule
What are some medical management to help urinary incontinence apart from lifestyle changes
- Indwelling catheter - urethral or suprapubic (invasive)
- Sheath device - analogous to an adhesive condom attached to catheter tubing and bag
- Incontinence pads
Explain specific medical management for SUI and UUI
- SUI management
- Pelvic floor muscle training
- UUI management
- Bladder training
- Schedule of voiding - void every hour during the day and not inbetween
- Bladder training
Describe pharmacological management of patients with SUI
- Duloxetine - combined noradrenaline and serotonin uptake inhibitor
- Increases activity in the striated sphincter during filling phase
Describe pharmacological management of patients with UUI
- Anticholinergics - act on muscarinic receptors (M2, M3)
- ß3 - adrenoceptor agonists
- Increases bladder’s capacity to store urine
- Intravesical injection of botulinum toxin
- Inhibits release of ACh at presynaptic neuromuscular junction causing targeted flaccid paralysis
Describe surgical interventions of female patients with SUI
- Permanent intention
- Low-tension vaginal tapes
- Lifts up urethra - closes urethra to prevent incontinence when undergoing stress
- Open retropubic suspension procedures
- Correct anatomical position of proximal urethra and improve urethral support
- Classical sling procedures
- Supports the urethra and augments bladder outflow resistance
- Low-tension vaginal tapes
- Temporary intention - eg. If further pregnancies are planned
- Intramural bulking agents
- Improve ability of urethra to resist abdominal pressure by improving urethra coaptation
- Intramural bulking agents
Describe surgical intervention for male patients with SUI
- Artificial urinary sphincter
- Cuff simulates action of normal sphincter to circumferentially close the urethra
- Mechanical device to press that opens cuff (sphincter)
- Male sling procedure
