Urogynaecology Flashcards
What is urinary incontinence
An involuntary loss of urine which can be objectively demonstrated
- social and hygiene problem
Describe the micturition cycle
1) Bladder fills
- detrusor muscle relaxes
- urethral sphincter contracts
- pelvic floor contracts
2) First sensation to void
- bladder is half full
- urination voluntarily inhibited until an appropriate time
3) Normal desire to void
4) Micturition
- detrusor muscle contracts
- pelvic floor relaxes
What interacts to allows the maintenance of continence
Brain Spinal cord and nerves - pelvic nerve - pudendal nerve Bladder Urethral sphincter Pelvic floor
Definition of dry overactive bladder
The symptoms of urgency, without urge incontinence, usually with frequency and nocturia
Definition of wet overactive bladder
The symptoms of urgency, with urge incontinence, usually with frequency and nocturia
Define urge incontinence
Leakage of urine in response to involuntary contraction of the detrusor muscle
Define stress urinary incontinence (SUI)
Leakage occurs with a rise in intra-abdominal pressure without a detrusor contraction (coughing, laughing, running and walking)
- sign or symptom of urinary leakage with increased intra- abdominal pressure
Define urodynamic stress incontinence
Urodynamic proven leakage of urine with an increase in intra-abdominal pressure
- old term = genuine stress incontinence
What is mixed incontinence
Co-existing SUI and OAB
- accounts for around 30% of incontinence cases in women
Risk factors associated with OAB
Neurological - MS - Parkinsons - Stroke - Cognitive function Mobility Alcohol Caffeine Acute UTI Constipation Previous surgery High urine production - medication - excess fluid intake - diabetes - poor kidney function Bladder abnormalities - tumour - stones
Aetiology of stress urinary incontinence
Loss of suburethral support causing urethral mobility
Intrinsic sphincter deficiency/primary urethral weakness
Suburethral support may be sufficient
Defective function of the striated and smooth muscle and mucosal and submucosal cushions
Risk factors associated with urinary incontinence
Pregnancy Childbirth Pelvic surgery radiotherapy Pelvic prolapse and repair Race Family predisposition Anatomical abnormalities Neurological abnormalities Drugs Menopause Cognitive impairment Increased intra-abdominal pressure Obesity Comorbidities Age
Implications of urinary incontinence on quality of life
Affects sleep, emotions, employment, exercise and sport, self-worth, relationships and socialising and travel and holidays
Questions in history that aid the diagnosis of type of urinary incontinence
Main symptoms - associated with increased intra-abdominal pressure - frequency - urgency - urge incontinence - nocturia - enuresis (bed wetting) - haematuria - dysuria - voiding problems - pain - prolapse symptoms Risk factors - mobility - mental agility - renal system - cardiac system - chest problems - drug therapies - previous pelvic surgery - obstetric history - menopausal status
Features of urinary incontinence on examination
Abdominal/bimanual examination
- pelvic masses
- palpable bladder
- impression of pelvic floor tone
Vaginal examination (bivalve/sims speculum, left lateral position)
- identify cervix or vaginal vault
- check walls in turn for prolapse, atrophy, fistulae and ulceration
- ask to cough and assess for urinary leakage