Urinary incontinence Flashcards
What is urinary incontinence
Involuntary loss of urine
What are types of urinary incontinence?
Stress: due to weakness of urinary outlet
Urge: due to detrusor overactivity
Mixed: bit of both
Functional: e.g. can’t get to the toilet
Bladder outlet obstruction e.g. prostate enlargement
Fistulae
What are Sx of incontinence?
Leakage of urine
Stress: when coughing, laughing, sneezing
Urge: sudden need to go in response to trigger e.g. sound of running water, caffeine
What are causes and risk factors for stress incontinence?
Childbirth pregnancy pelvic surgery e.g. hysterectomy obesity increasing age prolapse pelvic masses
What are causes and risk factors for urge incontinence?
Organic brain damage e.g. stroke, PD, dementia
Neurogenic bladder e.g. Diabetes, MS, PD
Bladder nerve problems e.g. Sensitisation of peripheral afferent terminals in bladder
Atrophic vaginitis
Medications e.g. diuretic, antidepressants, muscle relaxants
What important things to ask about in history?
Childbirth
Medications
Social e.g. caffeine and alcohol
Pelvic surgery
What Ix in urinary incontinence?
Frequency volume chart: quantify loss
Urinalysis
Post-void bladder scan: US after spontaneous void, volume > 200ml abnormal
Urodynamic studies: may be needed to differentiate, need to diagnose urge
Empty supine stress test: cough and see if leakage
What is Rx for stress incontinence?
Weight loss, reduce alcohol and caffeine
Pelvic floor exercises
Duloxetine can help increase contraction
oestrogen ring pessaries
Surgery e.g. tension tree vaginal tape
What is Rx for urge incontinence?
Reduce fluid intake, caffeine, alcohol
bladder retraining
Anti-muscarinics oxybutynin
Botox injection
What are complications of incontinence?
Surgery related • Urinary retention • UTI • Bladder perforation • Erosion of mesh
Psychological effects.
