Urinary Incontinence Flashcards
What are risk factors for urinary incontinence?
- Ageing population
- Obesity – maintaining BMI between 20-25 resolves USI in 40% and UUI in 30%
- Diabetes
Aims of Pelvic floor activation
• To clamp the urethra, increase urethral closure
pressure and prevent leakage Delancey 1994
• Build a structural support for the bladder and urethra Delancey 1994
• Prevent descent of the bladder neck and urethra during an abrupt increase in pressure by reflex activity Bo 2002
• Maintenance of the anorectal angle at 90o
What is involved in a Pelvic Floor Assessment?
- Takes 5mins – digital not with a speculum
- Assessing sensation – internal and external
- Assessing for muscle bulk, symmetry, over activity, pain, scar tissue and trigger points
- Assessing muscle strength using graded modified oxford scale
- Devised by Laycock and Jerwood in 2001
What are Physiotherapy Treatment
options
– for Muscle strengthening
- Individualised pelvic floor exercise programme – Squeezy App/Squeezy Cx
- Muscle stimulation (Neuromuscular Electrical stimulation - NMES)
- Biofeedback – Elvie
- Vaginal weights/Cones
Features of INITIAL ASSESSMENT in urogynae
- MSU
- VOIDING DIARY
- POST VOID RESIDUAL
- ABDOMINAL & PELVIC EXAMINATION: MASS PROLAPSE, MUSCLE TONE, ATROPHY
- QOL QUESTIONNAIRES
- IMPACT ON LIFE
- COPING METHODS
Core features of urogynae CONSERVATIVE MANAGEMENT
• LIFE STYLE CHANGES, • CAFFEINE REDUCTION
• LOSE WEIGHT,
• TREATMENT OF CHRONIC COUGH • FLUID MANAGEMENT
• TRIAL OF SUPERVISED PFE 3 MONTH
• PFE SHOULD BE OFFERED TO WOMEN WITH THEIR 1STH
PREGNANCY
• BLADDER RETRAINING 6 WEEKS
Treatment option for overactive bladder
- Antimuscarinic (Anticholinergics)
- Beta Adrenoreceprots ( Mirobegron)
- Botulinum Toxin Injections
- Antibiotics
NICE recommendation on overactive bladder (OAB) medication
- Do not offer oxybutynin (immediate release) to frail older women
- Offer one of the following choices first to women with OAB or mixed UI:
• oxybutynin (immediate release)
• tolterodine (immediate release)
• darifenacin (once daily preparation)
What is MIRABEGRON?
MIRABEGRON IS A TREATMENT FOR OAB THAT WORKS DIFFERENTLY TO ANTIMUSCARINICS
Counsel on risks and benefits of Botulinum toxin A for overactive bladder
• Being symptom free or having a large reduction in symptoms
• Risk of clean intermittent catheterisation
• The absence of evidence on duration of effect between treatments and the
long-term efficacy and risks
• Risk of urinary tract infection.
Association between motor nerve lesions and bladder function
UMN lesion associated with overactive bladder
LMN associated with retention
Cardinal Bladder Symptoms (4)
frequency
urgency
pain
leak
Risk factors for bladder incontinence
- congenital abnormalities
- developmental factors (lack normal rise in ADH secretion at night)
- Female
- Childbirth
- Aging or menopause
- medical disorders (diabetes - polyuria can worsen incontinence)
- surgery or other trauma
- drug therapy (diuretics)
- raised intraabdominal pressure (peritoneal dialysis, pelvic mass)
Structures stretched in vaginal childbirth
- compression of bladder
- stretching of vaginal wall and pubocervical fascia
- compression of pudendal canal against pelvic wall (prolonged second stage can cause pudendal neuropathy)
- stretching of rectovaginal septum
- stretching of elevator ani muscle
Therefore multifactorial compromise, have to assess for urinary and bowel incontinence, prolapse and sexual function.
Older patients with urge, frequency and hematuria
you must exclude:
- UTI
- bladder cancer
