Urinary Incontinence Flashcards
What are the causes of incontinence?
- Stress incontinence: defects in pelvic floor / urethral sphincter deficiency.
- Urge incontinence: detrusor overactivity / neurological incoordination
- Overflow incontinence
- Fistulae
- Congenital
- Urethral diverticulum
- Other (UTI, faecal impaction, medication, immobility)
Hx to elicit in incontinence evaluaton?
- Leakage episodes
- Pad usage
- QoL questionairres
- Oral fluid intake (water, caffeine, alcohol)
- Prolapse symptoms
- Dysuria
- Painful bladder filling
- Haematuria
- Bowel symptoms (faecal incontinence, constipation)
- OHx, GHx
- PMAFOST
What medications should be asked for on history in incontinence evaluation?
- anti cholinergics
- diuretics
- anti hypertensives
Ix in incontinence evaluation?
- MSU
- PVR
- Bladder diary
- QoL questionairres
- Urodynamics / videourodynamics
- Cystourethroscopy
What is stress incontinence?
Involuntary leakage of urine with exertion
What causes stress incontinence?
- Increased IAP (pregnancy, cough, abdo mass, constipation, obesity)
- Damage to pelvic floor (pregnancy, delivery, surgery)
- Failure of intrinsic sphincter (trauma, reduced collagen)
Conservative Mx stress incontinence?
- Pelvic floor exercises
- biofeedback
- electrical stimulation
- pads
- incontinence pessary
Surgical management of stress incontinence?
Surgical: always trial conservative first, urodynamics performed before surgery.
- Burch colposuspension
- Peri urethral bulking agent injections
What are the types of urge incontinence?
- Overactive Bladder Syndrome: symptoms of urinary urgency, frequency and nocturia with or without urge incontinence
- Detrusor Overactivity
How is detrusor overactivity defined?
Urodynamic observation characterised by involuntary detrusor contractions during the filling phase which may be spontaneous or provoked.
Aetiology urge incontinence?
- Idiopathic
- Psychosomatic
- Neuropathic
- Complications of incontinence surgery
- Outflow obstruction
- Bladder pathology (stones, cancer)
Pathophysiology of urge incontinence?
Varies according to aetiology; common theme is change in property of detrusor smooth muscle predisposing bladder to unstable contractions
Mx urge incontinence?
- FR under 1.5L
- Restrict alcohol, caffeine
- Bladder retraining with PT
- Pharm: ACh
- Surg: botox
What is the MoA of anticholinergics used for OAB?
Anticholinergics: ACh released from postganglionic parasympathetic nerve terminals. Acts on muscarinic receptors in detrusor to initiate bladder contraction.
Oxybutynin, tolterodine, solifenacin, darifenacin
