Urinary Incontinence Flashcards
Pelvic Floor Muscles - Importance (5)
- Support pelvic organs in women
- Urine and fecal continence mechanism
- Support baby during pregnancy
- Control intra-abdominal pressure increase (coughing)
- Important role in sexual sensation and function
Urinary Incontinence - Definition & 3 Main categories
Involuntary loss of urine on effort or physical exertion or on sneezing or coughing.
- Stress urinary incontinence
- Urgency urinary incontinence
- Mixed
Stress Urinary Incontinence (SUI) - Definition and Mechanism
Loss of urine on effort or physical exertion/ sneezing or coughing. Normal voiding frequency, small amount of leakage.
Dysfunction of sphincter mechanism -> ↑ intra-abdominal pressure, sphincter cannot control the pressure.
Urgency Urinary Incontinence - Definition and Mechanism and Triggers
Unexpected desire to urinate, can result in leakage. High voiding frequency with large amount of leakage. May or may not be due to detrusor muscle overactivity.
Alcohol, coffee, bladder infection.
Common Causes in Men (3)
- Prostate enlargement.
- Dysfunction secondary to prostate cancer.
- Combination of bladder/sphincter function.
Common Causes in Women (2)
- Dysfunction of bladder/PFM associated with pregnancy, childbirth or menopause.
- Nerve damage innervating bladder muscles.
Risk Factors (6)
- Ageing
- ↑ BMI and obesity
- High impact exercises
- Smoking
- Diabetes, stroke, hypertension, Parkinson’s, arthritis.
- Women: childbirth and gynecological surgeries.
Importance of Physiotherapy (4)
- Promotes Pelvic floor awareness via biofeedback and exercises.
- Prevent recurrence of impairments
- Restore bowel/bladder/sexual and muscle function.
- Reduce nr. of episodes.
Essential Components of Basic Assessment (6)
- General assessment
- Symptom assessment
- Assessment of QoL impact
- Assessment of desire for treatment
- Physical examination
- Urinalysis
General Assessment - Subjective (10)
- HOPC (onset, triggers, nr. of pads per day)
- Which Type (stress, urgency, mixed)
- Storage symptoms vs voiding symptoms
- Severity (little, moderate, large amount)
- Duration/frequency of symptoms
- Bowel/prolapse
- Effect of symptoms of sexual function
- Leakage during night?
- Social history (environment, lifestyle)
- PMH (medical and surgical treatments, meds, coexisting diseases, delivery and menstrual history)
Bladder Diary
Self-reported for 3 days.
When, what and how much the patient drinks.
Outcome Measures (7)
ICIQ: frequency, quantity, how it happens
BFLUTS: female lower urinary tract symptoms
I-QoL: quality of life
SUIQQ: stress and urge incontinence QoL
UISS: severity scale
SEAPI-QM
ISI: severity index
Physical Examination - Objective Assessment (3)
- General status (mental, obesity, physical dexterity and mobility)
- Abdominal examination (distended bladder, surgical scar)
- Pelvic examination: perineum, external genetalia, vaginal pelvic organ prolapse, PFM contractions.
Primary Goal of Physiotherapy
Reduce the frequency of episodes.
Physiotherapy Management - Approach (5)
Holistic
Evidence based
Patient centered care
Education
Multidisciplinary approach
