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Reproductive Health > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

What are the types of urinary incontinence

A

Urge incontinence
Stress incontinence

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2
Q

What is urge incontinence

A

Overactivity of the detrusor muscle of the bladder

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3
Q

How does urge incontinence present

A

Sudden urge to pass urine, rush to bathroom, not neccessaruly in time
Conscioious about toilet being available at all times

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4
Q

What is stress incontinence

A

Weak pelvic floor muscles and sphincter muscles - urine leaks when increased pressure on bladder eg laugh, cough

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5
Q

What is mixed incontinence

A

urge incontinence and stress incontinence

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6
Q

What is overflow incontinence and who is it more common in

A

Chronic urinary retention due to obstruction of flow of urine, incontinence without urge to pass urine
More common in men

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7
Q

What can cause overflow incontinence

A

Anticholinergics
Fibroids
Pelvic tumours
Nuerological conditions eg MS neuropathy, spinal cord injuries

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8
Q

Risk factors for urinary inctoninence

A

Increased age
Postmenopausal status
Increased BMI
Prev pregnancies and vaginal deliveries
Pelvic organ prolapse
Pelvic floor surgery
Neurological conditions eg MS
Cognitive impairment and dementia

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9
Q

What should be done if women present with overflow incontinence

A

Referred for urodynamic testing and specialist management

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10
Q

What modifiable risk factors can contribute to incontince

A

Caffeine
Alcohol
Medications
BMI

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11
Q

Severity incontinence questions to ask

A

Frequency urination
Frequency incontinence
Nighttime urination
Ue of pads and changes of clothing

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12
Q

What should examination for urinary incontinence assess

A

Pelvic tone and examine for:
Pelvic organ prolapse
Atrophic vaginitis
Urethral diverticulum
pelvic masses
Ask patient to ocugh and watch for leakage

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13
Q

How assess pelvic muscle contractions

A

Bimanual examination
Ask woman to squeeze against fingers

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14
Q

How grade pelvic muscle contractions

A

0 - no contraction
1 - faint contraction
2 - weak contraction
3 - moderate contraction with some resistnace
4 - good contraction with resistance
5 - strong contraction a firmsqueeze, drawing inwards

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15
Q

Investigations for incontinence

A

Bladder diary completed
Urine dipstick
Post void residual bladder volume (bladder scan)
Urodynamic testing

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16
Q

wHY DO URINE dipstick in urine incontinence

A

assess infection, microscopic haematuria and other path

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17
Q

What does a bladder diary contain

A

should be completed, tracking fluid intake and episodes of urination and incontinence over at least three days. There should be a mix of work and leisure days.

18
Q

What is urodynamic testing used to investigate

A

Urge incontinence that isnt responding to first line medical treatments, difficulties urinating, urinary retention, prev surgery or unclear diagnosis

19
Q

What do patients need to do 5 days before urodynamic test

A

Stop taking anticholinergic and bladder related medications around five days before tests

19
Q

What do patients need to do 5 days before urodynamic test

A

Stop taking anticholinergic and bladder related medications around five days before tests

20
Q

How is a urodynamic test carried out

A

Thin catheter inserted into bladder, another into rectum. Used to measure differences in pressure to compare

21
Q

What outcomes are measured in urodynamic testing

A

Cystometry
Uroflowmetry
Leak point pressure
Post void residual bladder volume
Video urodynamic testing - only when necessary, not routine

22
Q

What does cystometry measure

A

Detrusor muscle contraction and pressure

23
Q

What does uroflowmetry and post void residual bladder volume measure for

A

Flow rate
Incompltete emptying of bladder

24
Q

What is leak point pressure

A

point at which bladder pressure results in leakage of urine
Patient asked to cough, move or jump when bladder filled to various capacities
Assess for stress incontinence

25
Q

What does video urodynamic testing test for

A

Contrast and taking x ray images as bladder emptied. not routine

26
Q

Management of stress incontinence

A

Avoid caffeine, diuretics and overfilling bladder
Avoid excessive or restricted fluid intake
Weight loss (if appropriate)
Supervised pelvic floor exercises
Surgery
Duloxetine - SNRI second line where surgery less preferred

27
Q

What need to do before will consider surgery for incontinence

A

for at least three months before considering surgery

28
Q

What do for pelvic floor exercises

A

at least 8 contractions, 3 x daily

29
Q

What are the surgical options for incontinence

A

Tension-free vaginal tape
Autologous sling procedures
Colpsuspension
Intramural urethral bulking

30
Q

What is TVT

A

procedures involve a mesh sling looped under the urethra and up behind the pubic symphysis to the abdominal wall. This supports the urethra, reducing stress incontinence.

31
Q

Autologous sling procedures

A

work similarly to TVT procedures but a strip of fascia from the patient’s abdominal wall is used rather than tape

32
Q

What is colposuspension

A

Stitches connecting anterior vaginal wall forwards and adding support to the urethra

33
Q

What is intramural urethral bulking

A

Involves injections around urethra to reduce diameter and add support

34
Q

What cna do if stress incontinence cuased by neurorological disorder

A

Artificial urinary sphincter
pump inserted labia inflates deflates cuff around urethra, allowing women to control continence manually

35
Q

Management of urge incontinence

A

Bladder retraining = for at least 6 weeks = first line
Anticholinergic medication
Mirabegron
Invasive procedures - medical treatment fialed

36
Q

Example of anticholinergics used for incontinence

A

Oxybutinin, tolterodine and solifenacin

37
Q

Anticholinergic side effects, why especially difficult in older patients

A

Dyr mouth, eyes, urinary retention, constipation and postural hypertension
Can lead to cognitive decline, memory problems and worsening dementia

38
Q

What is mirabegon contraindicated in

A

Uncontrolled HPTN
BP monitored refuarlty

39
Q

How can mirabegon lead to stroke

A

Beta 3 agnoitst, stimulating sympathetic nervous system -> raised BP -> hypertensive crisis, increased risk TIA and stroke

40
Q

What are invasice options for overactive bladder failed repsonse medicine

A

Botulinum toxin tyoe A injection into bladder wall
Percutaneous sacral nerve stimulation
Augmentation cystoplasty - bowerl tissue enlarge bladder
Urinary diversion - redirect to urostomy in abdomen

Reproductive Health (69 decks)

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