7 - Incontinence Flashcards
(16 cards)
Define incontinence
An involuntary leakage of urine, occurs when bladder pressure exceeds urethral sphincter pressure
What symptoms present with issues in urine storage?
Frequency
Urgency
Nocturia
Incontinence
What symptoms present with issues in voiding?
Slow stream Splitting/spraying Hesitancy Intermittancy Straining
What symptoms present with post micturition problems?
Terminal dribble
Feeling of incomplete voiding
How does a chorda equina tumour affect micturition?
Compresses S2-S4
Decreased detrusor pressure, so large amount of residual volume and overflow incontinence. Reduced perianal sensation and lax anal tone
How does a spinal cord transection (upper motor neurone damage) affect micturition?
Dilates ureters, thickened detrusor so higher pressure when detrusor contracts.
Detrusor-sphincter dysynergia - poor co-ordination between bladder and sphincter results in pushing hard against closed sphincters, can cause renal deterioration
Define stress urinary incontinence
Involuntary leakage of urine on exertion/sneezing
Define urge urinary incontinence
Involuntary leakage of urine preceded by feelings of urgency
Define mixed urinary incontinence
Combination of stress and urge incontinence
Define overflow incontinence
Overfull bladder leaks, often without feelings of urgency
What form of incontinence is the most common?
Over active bladder syndrome
What are the risk factors for urinary incontinence?
Predisposing: Race, family history, anatomical/neurological abnormalities
Promoting: Pregnancy, prolapse, menopause, increased intra-abdominal pressure, obesity, UTI, age
What investigations would you conduct if incontinence is suspected?
Record volume of urine passed
See how many pads patient goes though, determine if leakage is constant or intermittent
Urine dipstick for UTI/haematuria/proteinuria/glucosuria
What non-pharmalogical management would you suggest for incontinence?
Weight loss Smoking cessation Decrease caffeine intake Timed voiding Indwelling catheter Incontinence pads Sheath device Pelvic floor muscle training
What pharmalogical management would you suggest for incontinence?
Duloxetine - NA and seratonin uptake inhibitor, increases activity in striated sphincter during filling phase
Anticholinergics eg Oxybutynin, acts on m2 and m3, but these have side effects on other m receptors
B3 agonist Mirabegion, increases bladder storage capacity
Botulinum injections to the detrusor, inhibits release of Ach at pre-synaptic junction causing paralysis of detrusor
Intramural bulking agents, improve urethral resistance to abdominal pressure by increasing urethral coaptation (drawing in)
What surgical procedures can help women with incontinence?
Vaginal tape to support mid urethra
Retropubic suspension procedures to correct anatomical position of proximal urethra and better support it
