urinary incontinence Flashcards
in whom are urinary incontinence more common in?
elderly females
what are the risk factors for developing urinary incontinence?
- advancing age
- previous pregnancy and childbirth
- high BMI
- hysterectomy
- fam hx
how is urinary incontinence classified?
- overactive bladder (OAB) / urge incontinence
- stress incontinence
- mixed incontinence
- overflow incontinence
what is an overactive bladder (OAB) / urge incontinence due to?
detrusor overactivity
what is stress incontinence?
leaking small amounts when coughing or laughing
what is mixed incontinence?
both urge and stress
what is overflow incontinence?
due to bladder outlet obstruction e.g. due to prostate enlargement
what is included in the initial ix for urinary incontinence?
- urine dipstick and culture - r/o UTI and DM
- bladder diaries - minimum 3 days
- VE - to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
- urodynamic studies
how is urinary incontinence managed if urge incontinence is predominant?
- bladder retraining (min. 6 weeks; gradually increase intervals between voiding)
- bladder stabilising drugs: anti-muscarinics 1st-line e.g. oxybutynin
- mirabegron (beta-3 agonist) may be useful if concerned about anticholinergic side-effects in frail elderly pts
how is urinary incontinence managed if stress incontinence is predominant?
- pelvic floor muscle training
- at least 8 contractions 3x per day for a min. 3 months - surgical procedures
- e.g. retropubic mid-urethral tape procedures - duloxetine if decline surgery
- combined noradrenaline and serotonin reuptake inhibitor
- MOA: increased synaptic concentration of noradrenaline and serotonin within pudendal nerve → increased stimulation of urethral striated muscles within sphincter → enhanced contraction
what should be suspected in pts with continuous dribbling incontinence after prolonged labour?
vesicovaginal fistulae
