Urinary incontinence Flashcards
What is stress urinary incontinence?
Involuntary leakage on effort or exertion, on sneezing or coughing
What is urge urinary incontinence?
Involuntary leakage accompanied by or preceded by urgency
What can cause incontinence?
Overactive bladder Weakened pelvic floor Nerve damage Bladder condions Other- e.g. constipation
What are the risk factors for incontinence?
Parity Increasing age Menopause Smoking Increase intra abdominal pressure Pelvic floor trauma Denervation Connective tissue disease Surgery Medical problems
What are the irritation symptoms that can come with incontinence?
Irgency Frequency >7x a day Nocturia Dysuria HAmoaturia
What are the possible voiding symptoms with incontinence?
Straining to void
Interupted flow
Recurrent UTI
What are the possible prolapse symptoms that can come with incontinence?
Vaginal lump
Dragging sensation in vagina
What are the possible bowel symptoms that may come with incontinence?
Anal incontinence
Consiptaion
Faecal evacuation dysfunction
IBS
What history should be taken in urinary incontinence?
Parity- mode of delivery, weight of biggest baby
Smoking
HRT
Medical conditions
Previos pelvic floor muscle training, surgical treatment of incontinence or prolapse
Quality of life
What medical conditions should be enquired about with incontinence?
DM Anti HTN medications Glaucoma Heart, kidney, liver Cognitive Anti-depressants/anti-psychotics
What is recommended to be done for anyone with incontinence?
3 day urinary diary
What is looked at in a urinary diary?
Fluid intake Urine output Daytime frequency Nocturia Average voided volume
What examinations should be done with incontinence?
General Abdo Neuro Gynae Pelvic floor assessment
What investigations should be done for incontinence?
Urine dipstick and MSSU
Post ovoidal residual volume assessment
Urodynamics- if surgical treatment considered
What can be done for lifestyle management of incntinence?
Smoking cessation
Weight loss
Healthy diet- avoid constipation
Stop drinking alcohol and caffeine
What are the medical treatment options for stress incontinence?
Duloxetine
What are the indications to use duloxetine in stress incontinence?
Pelvic floor training failed or would be enhanced by duloxetine
Doesn’t want/ not fit for surgery
Failed surgery
Patient wishes to have more children
What are the medical options for treatment of urge incontinence?
Anti-muscarinic
Tricyclic antidepressants
Botox
Neuromodulin
What are the physiotherapy options for treatment of incontinence?
Pelvic floor muscle training
What are the surgical options for management?
Tension free vaginal tape
Colposuspension
What is overactive bladder syndrome?
symptom complex usually, but not always, related to urodynamically demonstrable detrusor overactivity
What are the risk factors for overactive bladder syndrome?
Advanced age
DM
UTI
Smoking
What are the signs and symptoms of overactive bladder syndrome?
Urgency, with or without urge incontinence
Frequency
Nocturia
What is the management of overactive bladder syndrome?
Treat symptoms Normalise fluid intake Reduce caffeine, fizzy drinks, chocolate Smoking cessation Weight loss Bladder training programme Pharm
What is a bladder training programme?
Timed voiding with gradually increasing intervals
