Female Urinary Incontinence Flashcards
(48 cards)
What is the upper urinary tract?
Kidneys & ureters
Low pressure distensible conduit with intrinsic peristalsis
What is the lower urinary tract?
Bladder & urethra
Low pressure storage of urine
How quickly does the bladder fill with urine?
0.5-5mls/min
What is the nerve supply to the bladder?
Hypogastric nerve (sympathetic) T10-L2 - STORAGE
Pelvic nerve (parasympathetic) S2-4 - VOIDING
Pudendal nerve (somatic, voluntary) - S2-S4
What cortical activity occurs during bladder filling?
Activation of reciprocal guarding reflex by rhabdosphincter (sphincter consisting of striated muscle) contraction, increased sphincter contraction & resistance
Sympathetic activation, reciprocal parasympathetic inactivation –> mediates contraction of bladder base & proximal urethra
What occurs in bladder emptying?
Detrusor contraction
Urethral relaxation
Sphincter co-ordination
Absence of obstruction or anatomical shunt
Cortical influence (pontine micturition centre) –> activation of parasympathetic pathway and inhibition of sympathetic pathway
Define urinary incontinence
Any involuntary leakage of urine
Define stress urinary incontinence
Any involuntary leakage of urine on effort/exertion/sneezing/coughing
Define urge urinary incontinence
Involuntary leakage accompanied by or immediately proceeded by urgency
Define mixed urinary incontinence
Involuntary leakage accompanied by or immediately preceded by urgency & on effort/exertion/sneezing/coughing
Prevalence of IU increases with what?
Age
UI is not lifethreatening so why do we Rx it?
QoL issue
Impairs relationships, activity, emotion and mental well being
May lead to embarrassment and low self-esteem
What are the risk factors for UI?
Age Parity Menopause Smoking Medical problems Increased intra-abdominal pressure (heavy physical labour) Pelvic floor trauma (e.g. childbirth) Denervation Connective tissue dx Surgery
What are the main RFs for stress incontinence?
Pregnancy & childbirth
What do you want to ask in your hx of UI?
Age, parity, mode of delivery, wt of heaviest baby, smoking, HRT Medical conditions Prev pelvic muscle floor trauma/training, surgical Rx of SUI or POP Irritation symptoms Incontinence symptoms Voiding symptoms Fluid intake Effect on QoL out of ten Prolapse symptoms Bowel symptoms
What do you want to ask about irritation symptoms?
Urgency - sudden, compelling desire to void that is difficult to feder Increased daytime frequency (>7x) Nocturia (>1x) Dysuria Haematuria
What do you want to ask about voiding symptoms?
Straining to void
Interrupted flow
Recurrent UTI
What do you want to ask about fluid intake?
Quality & quantity
What do you want to ask about prolapse symptoms?
Vaginal lumps
Dragging sensation in vagina
What bowel symptoms do you want to ask about?
Anal incontinence
Constipation
Faecal evacuation dysfunction
IBS
What should be your initial assessment of a patient with UI?
3 day urinary diary
Fluid intake, urine output, daytime freq, nocturia, avg. voided volume, caffeine intake, accidents and what she was doing at the time
How do you examine a woman with bladder/pelvic floor problems?
Ht, wt
Abdominal - bladder distension
Neurological - esp sacral segment, assess lower limb movement, cognitive dx (esp in elderly), mobility
Gynae - prolapse, urogenital atrophy, pelvic mass, pelvic floor tone, strength, awareness
Pelvic floor assessment - Oxford scale
What is the Oxford grading scale for pelvic floor muscles?
0 - no muscle activity 1 - minor muscle flicker 2 - weak muscle activity wo circular contraction 3 - moderate muscle contraction 4 - good muscle contraction 5 - strong muscle contraction
What Ix can you do for UI?
Urinalysis - multistix +/- MSSU
Post-voiding residual volume assessment (usually bladder scanning) - only if symptoms of voiding difficulties
Urodynamics - only if surgery contemplated
