Flashcards in Incontinence Deck (15)
Definition of urinary incontinence?
Involuntary leakage of urine
What percentage of women > 65 are affected?
How do the SNS and PSNS affect bladder filling and emptying (think in terms of bladder and sphincter)? Where is the central control of bladder emptying found?
SNS = storage (bladder relaxation and sphincter constriction)
PSNS = pee (bladder constriction and sphincter relaxation)
Central control in cerebral cortex and pontine switching centre
What are the two components of the external urethral sphincter?
The urethral mucosa on the inside and the muscles and ligaments of the pelvic floor on the outside
Name 5 causes of urinary incontinence
Stress incontinence - defect in pelvic floor/urethral sphincter deficiency
Urge incontinence - detruser muscle overactivity/neurological incoordination
Overflow incontinence - from inability of bladder to empty
Fistulae - often from pregnancy or surgery
Other (UTI, faecal impaction, meds - alpha blockers, immobility)
Compare the usual Hxs of a woman with stress vs urge incontinence
Stress - involuntary loss of urine on exertion (heavy lifting or something)
Urge - strong, sudden and uncontrollable desire to urge
Name 4 important questions to ask to gauge severity of incontinence
Name 3 symptoms that can accompany incontinence
Name 3 signs of incontinence on examination
Demonstrable incontinence (get them to cough)
Atrophy, erythema, scarring of vulva/vagina (vulvitis from incontinence)
Pelvic floor muscle strength (put fingers up vagina and get woman to squeeze)
Name 3 Ix for urinary incontinence. Which is best for distinguishing between urge and stress incontinence?
Urodynamics (look at urine flow, bladder contraction, urethral pressures)
Cystoscopy (if suspicious of obstructive lesion)
Urodynamics best for making diagnosis if unsure clinically
What is the usual urodynamic result for stress incontinence? For urge incontinence?
Stress - involuntary leakage of urine with increased abdo pressure, without a detrusor contraction
Urge - involuntary detrusor contractions during filling phase (empties when filling)
What is the difference between overactive bladder syndrome and detrusor overactivity?
OBS = description of symptoms of urinary urge, frequency and nocturia, which may or may not be due to destrusor overactivity
Compare the non-surgical and surgical management of stress vs urge incontinence
Non-surgical - pelvic floor exercises, pads, pessary
Surgical - Burch colposuspension, mid-urethral slings
Non-surgical - fluid restriction (1.5L/day), bladder retraining (physio), anticholinergics (oxybutynin, tolterodine) - blocks detrusor constriction, tricyclic antidepressants (anticholinergic effect), oestrogen
Surgical - cystoscopy + hydrodistension or Botox injection, sacral nerve stimulation
Name 5 causes of stress incontinence
Increased abdo pressure (pregnancy, obesity, chronic cough, constipation)
Damage to pelvic floor (pregnancy and delivery, surgery)