Urinary Incontinence Flashcards
What is urinary incontinence
Involuntary leakage of urine
Incontience is more common in whcih sex?
Females
Why is incontinence more common in females
No internal sphincter
What are the stages in the micturation cycle?
- Filling and storage phase
- Emptying of bladder (contraction of bladder, relaxation of sphincter)
How is the micturation relfex initiated?
Stretch receptors send signals via sacral nerves (S2 and S3) to the micturation centre
How does a spinal cord lesion impact continence?
Detrusor sphincter synergy
The urethral sphincter(s) will not relax
Incontinence can be split into which two categories?
Urethral
Extra urethral
What is urge incontinence?
Associated with detrusor muscle contraction
Sudden urge
What causes stress incontinence?
Incontinence due to intra-abdominal pressure increases
There is no detrusor contraction
(due to pelvic floor or loss of urethral function)
Why is smoking a risk factor for stress incontinence?
Coughing
Which physical examinations are appropriate for incontinence?
Abdominal (distension)
PR (anal tone, prostate)
PV
What is uroflowmetry?
Measures how much urine is flowing and how quickly
Which blood related investigations are useful for incontinence?
FBC
U&Es - checks renal function
What must be looked out for on cystoscopy?
Tumours
Bladder stones
Stricture
Fistula
Bladder neck
Vascularisation
What is urodynamics?
Two small catheters (one entered in bladder (and one rectum or vagina))
Tests pressure in bladder versus intraabdominal pressure
Difference gives detrusor muscle (bladder) pressure
Which lifestyle modifications can be undertaken for stress incontinence?
Weight loss
Stop smoking
Pelvic floor exercises
Which surgical options can be offered to people with stress unrinary incontinence?
Injection of bulking agents to bladder neck (may end up with retention)
Tape surgery (wraps around urethra to increase resistance)
Bring urethra into abdominal cavity more (intra-abdominal pressure will aid)
Artifical urinary sphincter (last resort)
What is the treatment for isolated urge incontinence?
Conservative - increase fluid intake, avoid caffeine
Pharmacotherapy - Anticolenergics, Beta 3 adrenergics
Surgery - botulinum toxin injection, neuromodulation, enterocystoplasty/ileal conduit
What is the main problem with using anticholenergics?
Affects cognitive function of patients
What is overflow incontinence associated with?
Outflow obstrcution
Bed wetting
Chronic retention
Huge palpable bladder
AKI
What is the treatment for overflow incontinence?
Catheter
Assess renal function
Long term catheter, intermittent self catheterisation, surgery
