Incontinence hx + counselling Flashcards
HPC exploration incontinence
S - urinary and not PV discharge
O - when?
C (how much) - few drops or tablespoons
T - symptoms have got worse since onset? what’s brought you in today?
A - STI & UTI symptoms, frequency, urgency, dysuria, dragging sensation below, bowel incontinence, change in sensation down below
E- coughing, sneezing, and laughing
S- identifies impact on social life
Initial assessment for all incontinence
Full set of obs
Abdominal/renal exam
Speculum exam +/- bimanual palpation - prolapse
Urinalysis - UTI
Could consider US Urinary Tract
Incontinence Ix steps
- urine dipstick - EXCLUDE UTIs
- bladder diaries 3 days
- vaginal exam - exclude prolapse
- urodynamic studies
reassure
2 in 100 adults
more common in older women
explain stress/urge incontinence
bladder fills with urine
outer gate (sphincter) normally closed, help from pelvic muscles
coordination between brain, bladder & pelvic floor muscles
in stress - cough, sneeze, laugh, exercise –> extra pressure on bladder –> leak
in urge ‘unstable’ ‘overactive’ - sudden urgent deside to urinate. common during sex, orgasm
causes of stress/urge
stress - weak pelvis, childbirth, increasing age, obesity
urge - stress, caffeine, alcohol // nerve/brain damage // UTI
RFs incontinence
Older age
Previous pregnancies + deliveries
Post menopausal
Obesity
Hysterectomy
FHx
Urge mx steps
lifestyle changes (accessible toilet, avoid triggers, reduce/normalise fluid quantities you drink, only go to toilet when you need, weight loss)
bladder re-training (6w)
oxybutynin (careful in old women) - doesn’t often work on its own. SEs: dry mouth, dry eyes, constipation, blurred vision
surgery
Stress mx steps
lifestyle changes (weight loss, stop smoking, incontinence pads)
PFEs (Kegel); electrical stimulation; biofeedback; vaginal cones
duloxetine - helps muscles around urethra
surgery - vaginal tape - day surgery: 2 small cuts in abdomen and 1 in vagina. 80-90% cure
explain pelvic floor exercises
squeeze muscle above entrance to anus. Imagine trying to
stop from urinating. Do at least 3x every day. Improves 6/10.
explain bladder retraining routine
keep a diary with amounts
after 2-3 days try to go on for as long as
poss by distracting self
keep up with diary – aim for passing urine only 5-6 times in 24
hours
explore surgical options for urge incontinence
Sacral nerve stimulation (bladder implant)
Augmentation cystoplasty: tissue from intestine to increase size of the bladder. May need catheter.
Urinary diversion. ureters routed outside body. If all other options failed
Botulinum toxin A injected into sides of bladder. damps down contractions. May need
catheter
