Urinary Incontinence (Complete) Flashcards
What is urinary incontinence?
Unintentional passing of urine
What are the 5 main types of urinary incontinence?
Stress incontinence
Urge incontinence
Overflow incontinence
Functional incontinence
Mixed incontinence
What is stress incontinence?
What are two main risk factors?
Leaking of urine when laughing or coughing
Risk factors:
Pregnancy
Hysterectomy
What is urge incontience?
What are some risk factors for urge incontience?
A a sudden urge to urinate followed quickly by uncontrollable leakage of urine
Risk factors:
Age
High BMI
Recurrent UTIs (inflammation triggers bladder overactivity)
Smoking (inflammation and irritation of bladder triggers bladder overactivity)
Caffeine
What is overflow incontience?
Give 2 examples of causes
Incontinence due to bladder flow obstruction
BPH
Underactivity of the detrusor muscle such as from neurological damage
What is functional incontinence?
Give 3 examples of causes of functional incontience.
Impaired ability to get to the bathroom in time.
Causes:
Dementia
Alcohol
Sedating medication
What is mixed incontinence?
Combination of urge and stress incontience
What are the risk factors for urinary incontience?
Age
Previous pregnancy
High BMI
Hysterectomy
Family history of urinary incontince
Urge incontience is also known as?
Overactive bladder
What are the main investigations for urinary incontinence?
Bedside:
Bladder diary (3 days)
Vaginal examination: To check for pelvic organ prolapse. Check ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
Urinary dipstick/Urinalysis: Help to rule out infection as an acute cause
Imaging:
Urodynamic studies (1st line invasive after investigations above)
Cystometry: Measures bladder pressure whilst voiding. Only used if diagnosis isnt clear from history taking and other investigations.
Cystogram: Checks for fistual is suspected
Why is vaginal examination useful in investigating urinary incontinence?
Can help check for pelvic organ prolapse
Can check ability to voluntarily move the pelvic floor (‘Kegel’ exercises)
Management of urinary incontinence depends on the cause. What is the management plan for urge incontinence?
Lifestyle:
Bladder retraining: Aim to increase intervals between voiding.
Avoiding caffeine, fizzy and sugary drinks, excessive fluid intake
Pharmacological:
Antimuscarinics: e.g. oxybutynin (inhibits parasympathetic muscle activity)
Surgical:
Bladder instillation: Injection of Botox to paralyse the detrusor muscle
Sacral neuromodulation: for patient who have failed or are unsuitable for all other treatments.
Name 3 examples of anti-muscarinics used in treatment of urge incontinence.
Oxybutynin
Tolterodine
Darifenacin
What type of anti-muscarninc should be avoided in treatment of urge incontince in frail women?
Oxybutynin
What type of medication can be considered in treatment of urge incontinence in frail elderly patients if concern of effects of anti-cholinergic burden of muscarinics?
Beta-3 agonists such as:
Mirabegron
Management of urinary incontinence depends on the cause. What is the management plan for stress incontinence?
Lifestyle changes:
Pelvic floor muscle training: 8 contractions performed 3 times per day for a minimum of 3 months
Avoiding caffeine, fizzy and sugary drinks, excessive fluid intake
Pharmacological
Duroextine (SNRI): Given if surgery is unavailable
Surgical:
Retropubic mid-urethral tape procedures
