Urinary incontinence Flashcards
What should you consider before inserting a catheter?
Carry out a rectal exam to exclude rectal impaction causing the retention
Is the bladder still palpable after voiding (retention with overflow)
Is there a neuro cause of retention (Parkinson’s, cauda equina)
What is the main cause of incontinence in men?
Prostate problems
What are the types of incontinence in women?
Functional incontinence - immobility causes patient to be caught short
Stress incontinence - leakage from an incompetent sphincter when pressure rises e.g. coughing or laughing
Urge incontinence - urge to urinate causes detrusor contraction and loss of control
What are the causes of stress incontinence?
This is caused by pelvic floor weakness/prolape/pelvic floor weakness
Common following pregnancy
What are the causes of urge incontinence?
Urge incontinence is caused by detrusor overactivity e.g. inhibitory pathway malfunction or urinary infection
What is the management of stress incontinence?
Check for UTI, DM, DIuretics, faecal impaction, palpable bladder
- Pelvic floor exercises are first line
- Ring pessary for prolapse
- Medical - duloxetine (antidepressant) reduces incontinence
- Surgical options e.g. midurethral stabilization and urethral bulking
What is the management of urge incontinence?
Check for UTI, Diuretic use, DM, faecal impaction, palpable bladder, GFR
- Patient should fill in an incontinence chart for 3 days to identify triggers and define pattern
- Examine for spinal cord or CNS signs
- bladder training and weight loss important
- consider absorbent pad
What are some of the medications for detrusor overactivity in urge incontinence?
Antimuscarinics e.g. tolterodine - improves frequency and urgency
Oestrogens - helps post menopausal urgency
Beta agonist - raises bladders sensor threshold and occasionally helps
Botulinum toxin injection
Neuromodulation through sacral nerve stimulation
