Female Urinary Incontinence Flashcards
What are the major risk factors for developing Urinary Incontinence?
Age Parity Menopause Smoking Pelvic Floor Trauma Denervation CT Disease Surgery Preg &childbirth!
What do you want to know about incontinence?
- Irritation symptoms : frequency, urgency, nocturia, dysuria & haematuria
- Incontinence and what type e.g. stress, urgency, coital
- Severity of incontinence
- Voiding symptoms e.g. Straining, interruption & UTIs
- Fluid intake: quantity and content
- Prolapse symptoms e.g. lump, heaviness or draggin sensation
- Bowel symptoms e.g. incontinence, constipation of IBS
What tests can you do for an incontinent woman?
HISTORY AND EXAM FIRST
- 3 day urinary diary
- Urine dipstick
- Exams (general, abdo, neuro, pelvic)
- Pelvic floor Assessment
- Bladder Scan (Residual volume)
- Urodynamics (if considering surgery)
How do we grade a pelvic floor assessment?
Oxford Scale
In what way’s can we manage incontinence?
- Lifestyle (Smoking, weight loss, healthy eating to prevent constipation, alcohol & caffeine)
- Medical
- Physio
- Surgery
Define Stress Urinary Incontinence?
Intrabdominal pressure > urethral pressure –> Leakage on coughing, straining, sneezing etc
How can we increase the closure pressure of the urethra in stress incontinence?
- Pelvic floor training/PHYSIO
- Surgery
- Meds (Duloxetine - after muscle training & surgery)
What surgery can we provide for stress incontinence?
Tension Free Vaginal Tape
Colposuspension
Define Overactive Bladder Syndrome
Symptom complex usually due to Detrusor Overactivity:
- Urgency +/- urge incontinence
- Frequency
- nocturia
What risk factors apply specifically to Urge Incontinence?
- Old
- DM
- UTI
- Smoking
How do we manage OAB?
Lifestyle:
- Normalize fluids
- Lower caffeine, fizzy and chocolate
- Smoking cessation
- Wt loss
Bladder Retraining
Meds
New stuff includes botox & neuromodulation
How does bladder retraining work?
Times voiding with increasing intervals to re-estrablish cortical control over the detrusor
So what medications are available for OAB?
- Antimuscarinincs e.g. Oxybutinin
- TCAs
How does the mechanism of bladder filling work
Sympathetic system activated (encourages storage)
Inhibition of parasympathetic
Mediates contraction of bladder base and proximal urethra
Inhibition of contraction by gradual awareness of filling
How does the bladder emptying system work
Inhibition of sympathetic pathway Activation of parasympathetic pathway Detrusor contaction Urethral relaxation Absence of obstruction
