Urology: Urinary Incontinence Flashcards
What are the types of urinary incontinence?
Stress = leakage associated with increased abdo pressure from laughing, sneezing, coughing, climbing stairs
Urge = leakage accompanied by or immediately preceded by urgency
Mixed = combination of stress and urge incontinence, marked by involuntary leakage associated with urgency and also with exertion, effort, sneezing, or coughing
Functional = inability to hold urine due to reasons other than neuro-urologic and lower urinary tract dysfunction (delirium, psychiatric disorders, urinary infection, impaired mobility)
What are the causes of urinary incontinence?
Temporary = alcohol, caffeine, carbonated drinks, sweeteners, chili
Urge = infection, DM, neurological disorder
Functional = physical or mental impairment keeps you from making it to the toilet in time
Constipation = compacted stool in the rectum causes nerves to be overactive and increase urinary frequency
Pregnancy = hormonal changes
Childbirth = weakened muscles
Menopause = less oestrogen that helps keep the lining of the bladder and urethra healthy
BPH
Hysterectomy
Obstruction
How should urinary incontinence be investigated?
Thorough Hx = quantity, frequency, duration, triggers, constant/intermittent, urgency, dysuria, pain with full bladder, UTIs, obstetrical Hx, Hx of pelvic surgery, CNS surgery, meds, smoking, alcohol, caffeine abuse
Physical exam
Urinalysis
Voiding diary
Cotton swab test
Cough stress test
Measurement of postvoid residual (PVR) urine volume
Cystoscopy
Urodynamic studies
How should stress incontinence be managed?
pelvic floor physiotherapy, anti-incontinence devices, and surgery
How should urge incontinence be managed?
changes in diet, behavioural modification, pelvic-floor exercises, and/or medications and new forms of surgical intervention
How should mixed incontinence be managed?
pelvic floor physical therapy, anticholinergic drugs, and surgery
How should overflow urinary incontinence be managed?
catheterization regimen or diversion
How should functional urinary incontinence be managed?
treatment of the underlying cause
What are the possible complications from urinary incontinence?
Skin problems = rashes, infections, sores
UTI
Impact on personal life = impact social, work, personal relationships
