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Year 3 > Urinary incontinence (URO) > Flashcards

Urinary incontinence (URO) Flashcards

1
Q

What is urinary incontinence?

A

Common condition characterised by uncontrollable leakage of urine

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2
Q

Which group of people is urinary incontinence most common in?

A

Elderly females

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3
Q

What are the types of causes of urinary incontinence? (3)

A
  • neurological causes
  • genitourinary causes
  • reversible causes
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4
Q

What are the neurological causes of urinary incontinence? (2)

A
  • multiple sclerosis
  • spinal injury
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5
Q

What are the genitourinary causes of urinary incontinence? (4)

A
  • trauma to pelvic floor
  • pelvic floor weakness
  • sphincter deficiency
  • bladder outlet obstruction
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6
Q

What are the reversible causes of urinary incontinence? (2)

A
  • diuretics
  • UTIs
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7
Q

What are the types of urinary incontinence? (4)

A
  • stress incontinence
  • urge incontinence
  • mixed incontinence (stress + urge)
  • overflow incontinence
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8
Q

What is stress incontinence?

A
  • pelvic floor laxity –> urethra loses support –> increase in intra-abdominal pressure overwhelms sphincter muscles
  • urination associated with sneezing, coughing, laughing, pregnancy
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9
Q

What is urge incontinence?

A
  • over-active bladder –> involuntary urination preceded by feeling of not having to go
  • overactivity of detrusor muscle –> strong sudden sense of urgency followed by involuntary leakage
  • associated with nocturia and polyuria, and can be due to UTI, stroke, Parkinson’s, MS
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10
Q

What is mixed incontinence?

A

Combination of stress and urge incontinence

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11
Q

What is overflow incontinence?

A

Caused by urinary retention due to bladder outlet obstruction or ineffective detrusor muscle –> bladder pressure increases to exceed urethral resistance –> leakage

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12
Q

What is a symptom of overflow incontinence?

A

Weak/intermittent urinary stream or hesitancy

Frequent loss of small amounts of urine

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13
Q

What are some causes of overflow incontinence? (3)

A
  • drug causes of urinary retention - TCA (amitriptyline) due to cholinergic effect, opioids
  • blockage due to - BPH, prostate cancer, urethral strictures, severe constipation, prolapsed uterus
  • ineffective detrusor - due to disorders affecting autonomic innervation of bladder e.g. DM, SC injury, CES, anticholinergics
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14
Q

What are some signs of urinary retention (overflow incontinence)? (3)

A
  • palpable bladder
  • suprapubic tenderness
  • delirium in elderly patients
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15
Q

What might you find on examination in urinary incontinence? (3)

A
  • vaginal bulge/pressure
  • urogenital atrophy
  • abnormal bulbocavernous and anal wink reflexes –> suggests disruption of sacral reflex
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16
Q

What are some risk factors for stress incontinence? (3)

A
  • vaginal childbirth
  • pregnancy
  • hysterectomy
17
Q

What are some risk factors for urge incontinence? (5)

A
  • advancing age
  • high BMI
  • smoking
  • caffeine
  • UTI, stroke, Parkinson’s, MS
18
Q

What are the first-line investigations for urinary incontinence? (5)

A
  • cough stress test - urine leakage
  • urinalysis - rule out UTI
  • post-void residual measurement
  • empty supine stress test
  • urodynamic studies - differentiate types of incontinence
19
Q

What does post-void residual measurement show in urinary incontinence?

A
  • after a spontaneous void
  • may confirm urinary retention if overflow incontinence suspected
  • determined with US or sterile catheterisation
  • elevated if >100mL or >50% voided volume
20
Q

What does empty supine stress test show in urinary incontinence?

A

Valsalva manoeuvre in dorsal lithotomy position after spontaneously voiding –> urine leakage if positive

21
Q

Why are bladder diaries completed in urinary incontinence?

A

To assess frequency and volume of micturition, completed for a minimum of 3 days

22
Q

What examination excludes pelvic organ prolapse in urinary incontinence?

A

Vaginal exam - also assesses ability to initiate voluntary contraction of pelvic floor muscles

23
Q

Why is urine dipstick and culture done for urinary incontinence?

A

To exclude UTI - can cause urgency, frequency and/or incontinence

24
Q

What investigation is requested for suspected bladder outflow obstruction (–> overflow incontinence), and what does it show?

A

Urodynamic studies showing:

  • increased detrusor pressure
  • reduced urine flow rate
25
Q

What is diagnostic for acute urinary retention?

A
  • bladder US diagnostic for acute urinary retention
  • post-void residual measurement (US or sterile catheterisation) can identify urinary retention
  • chronic high pressure urinary retention - if renal function is impaired/hydronephrosis –> typically due to bladder outflow obstruction
  • chronic low pressure urinary retention - normal renal function and no hydronephrosis
26
Q

What is the difference between chronic high pressure vs chronic low pressure urinary retention?

A
  • high pressure –> renal function impaired or hydronephrosis (typically due to bladder outflow obstruction)
  • low pressure –> normal renal function and no hydronephrosis
27
Q

What are some differential diagnoses for urinary incontinence? (5)

A
  • urogenital fistula - continuous urine loss with no association to other Sx or timing
  • ectopic ureter
  • UTI
  • atrophic urethritis/vaginitis - frequency and irritation with voiding
  • pregnancy - frequency w/o irritation or incontinence, low perceived bladder volume
28
Q

What lifestyle modifications can we prescribe for urinary incontinence? (3)

A
  • weight loss
  • diet changes (decrease alcohol and caffeine)
  • smoking cessation
29
Q

How do we manage stress incontinence?

A
  • 1st line: pelvic floor exercises
  • if urethral sphincter insufficiency - pseudoephedrine (alpha-blocker) or duloxetine (combined SNRI)
  • if caused by menopause - oestrogen replacement therapy
  • surgery (urethral hypermobility/displacement) - retropubic mid-urethral tape procedure, sling procedures (sling around NoB to support), retropubic suspension, retropubic colposuspension
  • peri-urethral bulking injection (constrict urethra)
30
Q

How do we manage urge incontinence?

A
  • 1st line - bladder retraining –> lasts for minimum of 6 weeks with aim to increase intervals between voiding
  • medications - oxybutynin (anticholinergic antimuscarinic = inhibits detrusor overactivity) or mirabegron (beta3 agonist)
  • neuromodulation
  • botulinum toxin type A
31
Q

When is oxybutynin contraindicated (urge incontinence)?

A

First-line pharmacological therapy is oxybutynin (anticholinergic) but CI in glaucoma and best avoided in frail/elderly –> mirabegron (beta3 agonist) is the medication of choice

32
Q

How do we manage overflow incontinence?

A
  • medications:
    • alpha blockers - prazosin, tamsulosin (relaxes smooth muscle in bladder neck)
    • cholinergic agents - bethanchol (increases bladder muscle tone)
  • surgery:
    • anterior colporrhaphy (vaginal prolapse)
    • colposuspension (stitches to support NoB)
  • intermittent self-catheterisation
33
Q

What are some complications of incontinence? (5)

A
  • depression
  • psychological stress
  • dermatitis/skin infections (due to prolonged contact with urine)
  • UTI
  • surgery-related: urinary retention, bladder perforation, haemorrhage, bowel injury, voiding disorders, wound complications
34
Q

What acute pathology can urinary retention lead to?

A

AKI

Year 3 (208 decks)

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