Urinary Incontinence Flashcards
What is urinary incontinence?
Involuntary leakage of urine
What are the various suptypes of urinary incontinence?
Stress incontinence Urge incontinence Mixed incontinence Overflow incontinence Continuous incontinence
What is the pathophysiology of stress incontinence?
Intra-abdominal pressure exceeds urethral pressure - due to weakness in pelvic floor muscles
What are the risk factors for stress incontinence?
Post-partum
Constipation
Obesity
Post-menopausal
Pelvic surgery (TURP)
What is the pathophysiology of urge incontinence?
Overactive bladder which leads to rise in intravesical pressure and subsequent leakage of urine.
May be due to neurogenic causes, infection, malignancy or idiopathic. Medication can also casue this.
What is overflow urinary incontinenc?
Complication of chronic urinary retention - streaching of bladder and loss of bladder senstaion.
Grossly distended and leads to leakage of urine
What is continuous urinary incontinence?
Constant leakage of urine.
Typically due to anatomical abnormality (ectopic ureter) or bladder fistulae (vesicovaginal fistula) or due to severe overflow incontinence.
What can be used to aid diagnoisis of urinary incontinence?
Bladder diaries
QoL questionaires ccan aid in quantifying severity of the condition
What investigations should be done for urinary incontinence?
Urine dipstick
Post-void bladder scan
Further investigations:
Urogynamic assessment - not routine before conervative managemnt
Outflow urodynamics
Cystoscopy
What is the conservative management for stress incontinence, apart from lifestyle advise?
Pelvic floor muscle exercises for at least 3 months
If limited response the duloxetine (SNRI) cause stonger urethral contractions
What is the conservative management for urge incontinence, apart from lifestyle advice?
Anti-muscarinic drugs - oxybutynin or tolterodine
Bladder training for minimum 6 weeks
What are the surgical options for stress incontinence?
Tension-free vaginal tape
Open colposuspension
Intramural bulking agents - majority
Artifical urinary sphincter - mainly in males
What are the surgical options for urge incontinence?
Botulinum toxin A injections
Percutaneous scaral nerve stimulation
Augmentation cystoplasty
Urinary diversion via ileal conduit
What are some of the neuro-urological incontinence conditions?
Spina bifida - neurogenic OAB or stress incontinence
Spinal cord injury - detrusor sphincter dyssyenrgia
Diabetes
MS
Parkinsons
