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2: Female Incontinence Flashcards

(58 cards)

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1
Q

Define incontinence

A

Involuntary leakage of urine

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2
Q

What are the 5 types of incontinence

A
  • Functional
  • Urge
  • Stress
  • Mixed
  • Continuous
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3
Q

What is functional incontinence

A

Normal urinary system - however individual cannot make toilet in time

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4
Q

What is stress incontinence

A

Leakage from incompetence sphincter on increase in intra-abdominal pressure

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5
Q

What is urge incontinence

A

Sudden desire to urinate following by involuntary leakage of urine

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6
Q

What is continuous incontinence

A

Continual urinary leakage.

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7
Q

How does prevalence of incontinence change with age

A

Increases

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8
Q

What are the two causes of stress incontinence

A
  • Increase intra-abdominal pressure

- Weak pelvic floor, urethral hypermobility

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9
Q

What can increase intra-abdominal pressure

A
  • Pregnancy

- Obesity

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10
Q

What can cause pelvic floor weakness and urethral hyper mobility

A
  • Childbirth
  • Ageing
  • Oestrogen withdrawal
  • Previous pelvic surgery
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11
Q

What are the causes of urge incontinence

A

Higher cortical dysfunction:

  • Stroke
  • PD
  • Dementia

Peripheral Neuropathy:
- Diabetes

Other:

  • UTI
  • Diuretics
  • Atrophic vaginitis
  • Urethritis
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12
Q

What is mixed incontinence

A

Stress and urge incontinence

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13
Q

What causes continuous incontinence

A

Vesicovaginal fistula

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14
Q

What are causes of functional incontinence

A
  • Dementia

- Immobility

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15
Q

How does urge incontinence

A

Strong desire to urinate followed by urination

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16
Q

How does stress incontinence present

A

Leakage small amounts of urine on increase IAP

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17
Q

How does mixed incontinence present

A

Stress and urge

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18
Q

How does continous incontinence present

A

Continuous leakage urine at all times

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19
Q

What two muscles help maintain continence

A
  • Internal sphincter

- External sphincter

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20
Q

What type of muscle is internal sphincter

A

smooth muscle

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21
Q

What type of muscle is external sphincter

A

skeletal muscle

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22
Q

Describe control of internal sphincter

A
  • Involuntary
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23
Q

Describe control of external sphincter

A
  • Voluntary
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24
Q

What happens when bladder fills

Study These Flashcards
A

Bladder fills trigger stretch receptors that sign spinal cord (S2,S3) and pontine micturition centre to increase parasympathetic stimulation causing detrusor to contract and internal sphincter to relax. It also decreases motor nerve stimulation to external sphincter.

25
If wanting to voluntary inhibit urination what happens
Pontine centre inhibitors
26
what happens in urge incontinence
neurogenic disorders cause autonomous contraction of detrusor and uncontrollable micturition
27
what happens in stress incontinence
increase intra-abdominal pressure causes pressure inside abdomen to overcome sphincter pressure - leading to incontinence.
28
what is first line investigation for use incontinence
Urinalysis
29
what is looked for on urinalysis
- Glycosuria | - Nitrites and haematuria
30
what examination is performed in urge incontinence
Pelvic exam - to look for prolapse or atrophic vaginitis
31
what investigation is recommended for patients with urge incontinence following urinalysis and pelvic exam
Bladder diary
32
how long is a bladder diary kept for
3-days
33
what does bladder diary look at
- Input - Output - Urgency - Frequency and volume of urination
34
how is post-residual volume measured
Bladder USS
35
what is first line for managing urge incontinence
conservative: lifestyle advice
36
what is second-line for urge incontinence
supervised bladder training (6-weeks)
37
how long is supervised bladder training carried on for
6-Weeks
38
what medication is offered for urgent incontinence if supervised mechanism have failed
Oxybutynin (Tolterodine)
39
when should oxybutynin (tolteridine) not be offered and why
>75-years due to exacerbating delirium. Use mirabegron instead
40
how long does tolterodine take to work and hence when should patient be reviewed
4W
41
what is fourth-line for urge incontinence
botulism injection in bladder
42
when should incontinence pads only be used in urge incontinence
whilst awaiting treatment
43
what is first line for investigating stress incontinence
Pelvic exam
44
why is pelvic exam performed in stress incontinence
- Look for pelvic floor weakness
45
what is the stress test
Ask patient to cough and small amount of urine will leak out
46
what is performed prior to surgery in women with stress incontinence
Urodynamic studies
47
what is first-line for stress incontinence
Conservative: lifestyle advice
48
what 4 pieces of lifestyle advice may be given
1. Smoking cessation 2. Reduce caffeine 3. Reduce alcohol 4. Weight loss
49
what is second-line management of stress incontinence
supervised pelvic floor training
50
what is supervised pelvic floor muscle training also known as
Kegel exercises
51
what are kegel exercises
8 contractions, 3 times a day - for 3-months
52
if Kegel exercises have failed what is offered
Surgery
53
what types of surgery may be offered for stress incontinence
Mid-urethral tape Colposuspension Rectal-fascial sling Bulking agents
54
if a patient is unsuitable for surgery, what is indicated
Duolextine
55
what is the MOA of duolextine
NA and 5-HT re-uptake inhibitor
56
what is the pelvic floor made up of
levator ani | Coccygeus
57
what is the levator ani made up of
- Illiococcygeus - Puborectalis - Pubococcygeus
58
what is overactive bladder syndrome
urgency without urge incontinence

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