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GP Conditions Year 4 > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

2 types

A

urge and stress

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2
Q

What causes urge incontinence?

A

overactivity of detrusor muscle

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3
Q

presentation - urge incontinence

A

suddenly feeling urge to urinate

rush to bathroom

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4
Q

3 canals through pelvic floor

A

urethral
vaginal
rectal

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5
Q

what causes stress incontinence?

A

weak pelvic floor and sphincter muscles

urine leak when increased pressure on bladder

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6
Q

typical presentation of stress incontinence

A

urinary leakage when laughing, coughing or surprised

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7
Q

When can overflow incontinence occur?

A

chronic urinary retention

obstruction to outflow

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8
Q

What can cause overflow incontinence?

A 
anticholinergic meds 
fibroids 
pelvic tumours 
MS
diabetic neuropathy 
SCI
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9
Q

Who is overflow incontinence more common in?

A

men

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10
Q

women with overflow incontinence

A

referred for urodynamic testing

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11
Q

risk factors for urinary incontinence

A 
increased age
postmenopausal 
increased BMI
pregnancies and vaginal deliveries 
pelvic organ prolapse 
pelvic floor surgery 
MS 
dementia
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12
Q

modifiable lifestyle factors

A

caffeine and alcohol
medications
BMI

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13
Q

assessing severity

A

frequency of urination
frequency of incontinence
nighttime urination
use of pads/clothing

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14
Q

examination

A

assess pelvic tone
prolapse and masses
atrophic vaginitis
urethral diverticulum

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15
Q

How can strength of pelvic muscle contractions be assessed?

A

during bimanual exam

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16
Q

How is pelvic muscle contraction strength assessed?

A

0-5
0 = no contraction
5 = strong contraction

17
Q

4 main investigations

A

bladder diary - fluids and urination over 3 days
urine dipstick
post void residual bladder volume
urodynamic testing

18
Q

Urodynamic tests

A

thin catheter inserted into bladder and another into rectum

bladder filled with liquid

19
Q

5 things urodynamic tests can measure

A 
cystometry 
uroflowmetry 
leak point pressure 
post void residual bladder volume 
video urodynamic testing
20
Q

cystometry

A

detrusor muscle contraction and pressure

21
Q

uroflowmetry

A

flow rate

22
Q

leak point pressure

A

point at which bladder pressure results in leakage of urine

cough when bladder filled to various capacities

23
Q

Important before management plan

A

distinguish between stress and urge

24
Q

Management options - stress

A 
avoid caffeine, diuretics
avoid excessive fluid
weight loss
PFMT
duloxetine or surgery
25
Q

surgical options - stress incontinence

A

tension free vaginal tape
autologous sling
colposuspension
intramural urethral bulking

26
Q

tension free vaginal tape

A

mesh sling looped under urethra and up behind pubic symphysis

27
Q

Autologous sling procedures

A

similar to TVT - strip of fascia used rather than tape

28
Q

colposuspension

A

stitches connecting anterior vaginal wall and pubic symphysis

29
Q

treating stress incontinence caused by neurological disorder

A

artificial urinary sphincter

30
Q

Managing urge incontinence

A

bladder retraining
anticholinergic meds
mirabegron
invasive procedures

31
Q

bladder retraining

A

gradually increasing time between voiding for atleast 6 weeks

32
Q

first line treatment - urge incontinence

A

bladder retraining

33
Q

examples of anticholinergic meds used for urge

A

oxybutynin

34
Q

anticholinergic side effects

A 
dry eyes and mouth 
urinary retention 
constipation 
cognitive decline 
worsening dementia
35
Q

When is mirabegron CI?

A

uncontrolled hypertension

36
Q

How does mirabegron work?

A

beta 3 agonist

sympathetic NS - raised bp

37
Q

invasive treatment for OAB not controlled by meds or bladder retraining

A

botulinum toxin A injection
percutaneous sacral nerve stimulation
augmentation cystoplasty
urinary diversion

GP Conditions Year 4 (72 decks)

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