Urinary Incontinence Flashcards
What is meant by stress incontinence?
leakage on actions with raised pressure
e.g. sneezing or coughing
What causes stress incontinence?
bladder neck/urethral hypermobility
OR neuromuscular defects
=> causing intrinsic sphincter deficiency
What is urge incontinence?
leakage accompanied by or immediately preceded by urgency
What causes urge incontinence?
Bladder overactivity (detrusor instability)
Pathology irritating the bladder (infection, tumour, stone)
What does bed wetting in older men usually indicate?
High-pressure chronic retention
Why does post-micturation dribbling usually occur?
Dribble immediately after leaving the toilet
Small amount of residual urine in prostatic urethra should go back up to bladder
Instead it collects in the bulbar urethra further forward
What does a constant leakage of urine indicate?
FISTULA
Usually between bladder and vagina in females
- due to hysterectomy/ C-section
In what circumstance would a young girl have a constant leakage of urine?
Ectopic ureter draining into the vagina/ proximal urethra
What risk factors is it important to ask about in an incontinence consultation?
previous surgery
bowel symptoms
symptoms of sexual dysfunction
pelvic organ prolapse in women
What red flag symptoms should you consider asking in an incontinence history
pain haematuria recurrent UTI significant voiding/obstructive symptoms, Hx of pelvic surgery/radiotherapy
What should be included in a female pelvic examination?
- chaperone
- Ask Pt to cough/strain
=> look for vaginal wall prolapse and urinary leakage.
Internal examination to assess
- voluntary pelvic floor muscle strength
- bladder neck mobility
Inspect the vulva for vaginal atrophy (oestrogen deficiency)
A palpable bladder full of urine on examination indicates what?
Patient is in retention
How do patients construct a Bladder diary?
- Use a measuring jug to quantify the urine
- Write down what volume they passed and at what time of the day
Females usually have higher flow rates than men. TRUE/FALSE?
TRUE
Why is a two way catheter used in cystometry?
Allows on port for a water pump IN
and one port to measure bladder pressure
What is meant by bladder training?
When needing to void, holding on for a bit of time to train the ability of the bladder to hold urine for longer before voiding
What conservative treatments can be offered to help incontinence?
Pelvic floor exercises
Lifestyle modification
Medication – duloxetine
Electrical stimulation of pelvic floor
What injection can be used to help with incontinence?
injection of bulking materials into bladder neck and periurethral muscles
=> increase outlet resistance
Explain the aim of a retropubic suspension?
elevate and fix the bladder neck and proximal urethra in a retropubic position
=> support the bladder neck and regain continence
What is meant by an overactive bladder?
urgency, with or without urge incontinence
plus frequency and nocturia
caused by bladder (detrusor) overactivity
What conservative treatments are recommended for an overactive bladder
Pelvic floor exercises
Bladder training
Behavioural modification
avoid stimulants (caffeine, alcohol)
What anticholinergic/antimuscarinic medications can inhibit contractions and increase bladder capacity in an overactive bladder?
Oxybutynin
Solifenacin
Tolterodine
What drug class is Mirabegron and how does it help in an overactive bladder?
β3-AR agonists
=> increase bladder capacity with no change in micturition pressure and the residual volume
If conventional therapies for an overactive bladder are unsuccessful, what other therapies can be tried?
Intravesical Botox A
Neuromodulation
Augmentation “Clam” ileocystoplasty
Ileal conduit urinary diversion
Where is intravesical Botox A injected?
20 sites under bladder mucosa or into detrusor (sparing the trigone)
What is the purpose of a neuromodulation device?
sacral nerve stimulation
=> suppresses involuntary bladder contraction reflex
Describe what is meant by an Ileal conduit urinary diversion?
both ureters anastomosed
connected to a short length of ileum
Ileum brought out cutaneously as stoma (urostomy)
