Urinary Incontinence Flashcards
Urinary Incontinence Classifications
Functional
-Patient unable to reach toilet in time
Stress
-Involuntary leakage on exertion, sneezing, coughing
-Due to incompetent sphincter
Urge
-Incontinence immediately preceded by urgency
-Involuntary destrusor contraction
-Idiopathic or secondary to neurological problems
Mixed
-Involuntary leakage associated with both urgency and exertion, sneezing, coughing
Overactive bladder
-Urgency with or without urge incontinence
Overflow
-Chronic outflow obstruction e.g. prostatic disease
True
-Fistulous track between the vagina and the ureter, bladder or urethra, continuous leakage
Urinary Incontinence Epidemiology
-Mostly stress
Urinary Incontinence RFs
- Pregnancy, vaginal delivery, diabetes, oral oestrogen therapy, high BMI
- Frequent UTIs
- Neurological disease
Urinary Incontinence History
- Determine type
- Full obstetric history
- Bladder chart
- Sexual dysfunction
- Functional status
- Medication
- General Hx
Urinary Incontinence Examination
- Digital assessment of pelvic floor muscle contraction
- Bimanual
- Abdo, pelvic and neuro exam as well
Urinary Incontinence Ix
- Urine dipstick and culture is indicated
- Post-void residual scan for those with voiding issues
Urinary Incontinence When to Refer
- Incontinence associated with features suggestive of cancer
- Persisting pain, benign pelvic masses, associated faecal incontinence, neurological disease, voiding difficulty, urogenital fistulae suspected
Urinary Incontinence Management
-Temporary containment products to achieve social continence until specific management plan
Stress Incontinence
-Pelvic floor exercises
-Surgery if conservative management fails
-Duloxetine is surgery not wanted
Mixed Incontinence
-Pelvic floor exercises and bladder training first line
-Antimuscarinic (oxybutynin) if these are not effective
Overflow incontinence
-Relieve obstruction
