Urinary Incontinence Flashcards

1
Q

What are risk factors for urinary incontinence?

A
  • Ageing population
  • Obesity – maintaining BMI between 20-25 resolves USI in 40% and UUI in 30%
  • Diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Aims of Pelvic floor activation

A

• To clamp the urethra, increase urethral closure
pressure and prevent leakage Delancey 1994
• Build a structural support for the bladder and urethra Delancey 1994
• Prevent descent of the bladder neck and urethra during an abrupt increase in pressure by reflex activity Bo 2002
• Maintenance of the anorectal angle at 90o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is involved in a Pelvic Floor Assessment?

A
  • Takes 5mins – digital not with a speculum
  • Assessing sensation – internal and external
  • Assessing for muscle bulk, symmetry, over activity, pain, scar tissue and trigger points
  • Assessing muscle strength using graded modified oxford scale
  • Devised by Laycock and Jerwood in 2001
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are Physiotherapy Treatment
options
– for Muscle strengthening

A
  • Individualised pelvic floor exercise programme – Squeezy App/Squeezy Cx
  • Muscle stimulation (Neuromuscular Electrical stimulation - NMES)
  • Biofeedback – Elvie
  • Vaginal weights/Cones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Features of INITIAL ASSESSMENT in urogynae

A
  • MSU
  • VOIDING DIARY
  • POST VOID RESIDUAL
  • ABDOMINAL & PELVIC EXAMINATION: MASS PROLAPSE, MUSCLE TONE, ATROPHY
  • QOL QUESTIONNAIRES
  • IMPACT ON LIFE
  • COPING METHODS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Core features of urogynae CONSERVATIVE MANAGEMENT

A

• LIFE STYLE CHANGES, • CAFFEINE REDUCTION
• LOSE WEIGHT,
• TREATMENT OF CHRONIC COUGH • FLUID MANAGEMENT
• TRIAL OF SUPERVISED PFE 3 MONTH
• PFE SHOULD BE OFFERED TO WOMEN WITH THEIR 1STH
PREGNANCY
• BLADDER RETRAINING 6 WEEKS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment option for overactive bladder

A
  • Antimuscarinic (Anticholinergics)
  • Beta Adrenoreceprots ( Mirobegron)
  • Botulinum Toxin Injections
  • Antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

NICE recommendation on overactive bladder (OAB) medication

A
  1. Do not offer oxybutynin (immediate release) to frail older women
  2. Offer one of the following choices first to women with OAB or mixed UI:
    • oxybutynin (immediate release)
    • tolterodine (immediate release)
    • darifenacin (once daily preparation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is MIRABEGRON?

A

MIRABEGRON IS A TREATMENT FOR OAB THAT WORKS DIFFERENTLY TO ANTIMUSCARINICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Counsel on risks and benefits of Botulinum toxin A for overactive bladder

A

• Being symptom free or having a large reduction in symptoms
• Risk of clean intermittent catheterisation
• The absence of evidence on duration of effect between treatments and the
long-term efficacy and risks
• Risk of urinary tract infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Association between motor nerve lesions and bladder function

A

UMN lesion associated with overactive bladder

LMN associated with retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cardinal Bladder Symptoms (4)

A

frequency
urgency
pain
leak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Risk factors for bladder incontinence

A
  • congenital abnormalities
  • developmental factors (lack normal rise in ADH secretion at night)
  • Female
  • Childbirth
  • Aging or menopause
  • medical disorders (diabetes - polyuria can worsen incontinence)
  • surgery or other trauma
  • drug therapy (diuretics)
  • raised intraabdominal pressure (peritoneal dialysis, pelvic mass)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Structures stretched in vaginal childbirth

A
  • compression of bladder
  • stretching of vaginal wall and pubocervical fascia
  • compression of pudendal canal against pelvic wall (prolonged second stage can cause pudendal neuropathy)
  • stretching of rectovaginal septum
  • stretching of elevator ani muscle

Therefore multifactorial compromise, have to assess for urinary and bowel incontinence, prolapse and sexual function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Older patients with urge, frequency and hematuria

you must exclude:

A
  • UTI

- bladder cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mechanism of cystocoele formation

A

stretching of vaginal fascia during childbirth

bladder descends due to loss of support -> bladder prolapse

usually associated with damage to bladder neck due to shared mechanism