Urinary Incontinence Flashcards
What are the symptoms of storage incontinence?
Frequency
Urgency
Nocturia
What are the symptoms of voiding incontinence?
Hesitancy
Dribbling
Incomplete emptying
Intermittent stream
What is stress incontinence?
Weak pelvic floor/urinary outlet - bladder can’t store urine. Made worse with strain
What is urge incontinence?
High bladder pressure - bladder can’t store urine:
Overactive bladder (idiopathic) Neurogenic
What are the causes of voiding incontinence?
Bladder outlet obstruction:
Prostate enlargement
Constipation
Pelvic masses
What is functional incontinence?
Incontinence due to general impairment eg dementia, immobility
Lifestyle management of incontinence
Reduce alcohol/caffeine intake Lose weight Manage constipation Reduce fluid intake Stop smoking Incontinence products Referral to continence services
Management of stress incontinence
- Conservative:
Lifestyle
Pelvic floor exercises
Vaginal come - Surgical - mid urethral sling insertion
- Duloxetine BD (SEs: dry mouth, constipation, fatigue, nausea)
Management of urge incontinence
- Conservative
Lifestyle
Bladder training - Medical
- antimuscarinics (act on M3 in detrusor to reduce contraction) (SEs: dry mouth, constipation, fatigue, blurred vision)- Oxybutynin (not frail or PD)
- Tolteridone
- Darifenacin
- Intravaginal oestrogens
- Surgical - refer to urology
Management of BPH
Medical
- alpha blockers (tamulosin, doxazocin) reduce smooth muscle tone in prostate
- 5 alpha reductive inhibitors (finesteride) block conversion of testosterone to dihydrotestosterone, reducing prostate volume
Surgical
- Transurethral prostatectomy (TURP)
What drug would you give to treat nocturia if conservative measures fail?
Desmopressin - decreases the amount of urine produced
Antidiuretic, vasopressin analogue, increases aquaporin channels in collecting duct allowing increased water reabsorption.
What are the causes of urge incontinence?
Idiopathic - overactive bladder
Neurogenic - MS, PD, stoke, SC injury
Bladder outlet obstruction
UTI
