Urinary Incontinence Flashcards
Who is more likely to be affected by urinary incontinence; males or females?
Females= twice as likely
Remind yourself of the types of urinary incontinence
*See Sem 3 Urinary for more detail
- Stress
- Urgency
- Mixed
- Overflow
State some risk factors for developing incontinence
- Age
- Pregnancy (vaginal delivery)
- Obesity
- Dementia
- MS
- Constipation
- Stroke & other neurological disorders
When asking about lower urinary tract symptoms, we can ask about voiding symptoms and sotrage symptoms. State soem examples of each
Voiding
- Hesitancy
- Straining
- Weak flow
- Terminal dribbling
- Prolonged voiding
- Retention/don’t fully empty
- Pain
Storage
- Frequency
- Urgency
- Nocturia
- urge incontinence
- Small voided volume
When taking a history from someone presenting with urinary incontinecne, what are some key questions you must ask?
- Lower urinary tract symptoms- voiding & storag
- Fluid intake & types
- Systems review of cardiorespiratory, neurological, GI- include bowel habits (type, frequency etc…)
- Ask about diabetes & CKD
- Obstetric history in women
- Medication
- Red flag symptoms:
- Haematuria
- Pain on micturition
- Prolpase behind entrance into canal/hollow organ e.g. vagina
- Suspicion of prostrate cancer
- Impact on life
State some medications which can cause urinary symptoms; for each state the symptoms they can cause
- Alcohol: polyuria, frequency
- ACE inhibitor: cough & stress incontinence
- Anticholinergic: urinary retention
- Diuretic:polyuria, frequency, urgency
- Opiate: constipation, urinary retention & overflow
- Tricyclic antidepressants: urinary retention & overflow
What investigtions would you do for someone with urinary incontinence/urinary symptoms, include:
- Bedside
- Bloods
- Investigations
Bedside
- Urinalysis
- Urine microscopy, culture & sensitivity
- Post-voided bladder scan
- Frequency volume chart (bladder diary)
- PR examination
- External genitalia review- particulalry looking for atrophic vaginitis in female
Bloods
- FBC: infection
- U&Es: ?CKD or
- HbA1c: if diabetic?
Imaging
- USS KUB
- Uroflowmetry
- Video urodynamics
What is meant by functional incontinence?
Incontinence due to cognitive impairment or behavioural problems.
Incontinence is a natural part of ageing; true or false?
FALSE- it is NOT a natural part of ageing
Discus the management of stress urinary incontinence
- First line= conservative
- Pelvic floor training
- Weight loss
- Smoking cessation
- Treating exacerbating factors e.g. chronic cough, constipation
- Pharmacological= duloxetine
Discuss the management of urgency urinary incontinence
- Conservative
- Bladder training
- Fluid moderation
- Avoid caffeine & alcohol
- Pharmacological
- Antimuscuranics: e.g. oxybutynin (antagonise M1, M2, M3) or mirabegron (B3 agonist)
- Surgical
- Cystoscopic botox injection
- Neuromodulation
State some potential complications of urinary incontinence
- Psychological impacts
- Decreased quality of life
What is overactive bladder?
Urgency +/-urge incontinence
Causes:
- Idiopathic
- Neurogenic
- Infective
- Bladder outlet obstruction
