Urinary incontinence Flashcards
2 types
urge and stress
What causes urge incontinence?
overactivity of detrusor muscle
presentation - urge incontinence
suddenly feeling urge to urinate
rush to bathroom
3 canals through pelvic floor
urethral
vaginal
rectal
what causes stress incontinence?
weak pelvic floor and sphincter muscles
urine leak when increased pressure on bladder
typical presentation of stress incontinence
urinary leakage when laughing, coughing or surprised
When can overflow incontinence occur?
chronic urinary retention
obstruction to outflow
What can cause overflow incontinence?
anticholinergic meds fibroids pelvic tumours MS diabetic neuropathy SCI
Who is overflow incontinence more common in?
men
women with overflow incontinence
referred for urodynamic testing
risk factors for urinary incontinence
increased age postmenopausal increased BMI pregnancies and vaginal deliveries pelvic organ prolapse pelvic floor surgery MS dementia
modifiable lifestyle factors
caffeine and alcohol
medications
BMI
assessing severity
frequency of urination
frequency of incontinence
nighttime urination
use of pads/clothing
examination
assess pelvic tone
prolapse and masses
atrophic vaginitis
urethral diverticulum
How can strength of pelvic muscle contractions be assessed?
during bimanual exam
How is pelvic muscle contraction strength assessed?
0-5
0 = no contraction
5 = strong contraction
4 main investigations
bladder diary - fluids and urination over 3 days
urine dipstick
post void residual bladder volume
urodynamic testing
Urodynamic tests
thin catheter inserted into bladder and another into rectum
bladder filled with liquid
5 things urodynamic tests can measure
cystometry uroflowmetry leak point pressure post void residual bladder volume video urodynamic testing
cystometry
detrusor muscle contraction and pressure
uroflowmetry
flow rate
leak point pressure
point at which bladder pressure results in leakage of urine
cough when bladder filled to various capacities
Important before management plan
distinguish between stress and urge
Management options - stress
avoid caffeine, diuretics avoid excessive fluid weight loss PFMT duloxetine or surgery
