Session 8 B Flashcards
(38 cards)
Types of incontinence
Stress, Urgency, mixed, overflow, over active bladder
What is stress urinary incontinence
Complaint of involuntary leakage on effort or exertion, or on sneezing or coughing
What is urgency urinary incontinence
The complaint of involuntary leakage of urine accompanied by or immediately proceeded by urgency
What is mixed urinary incontinence
The complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing
What is overflow incontinence (chronic urinary retention)
The involuntary release of urine when the bladder becomes overly full- due to a weak bladder muscle or to blockage
What is overactive bladder
A frequent and sudden urge to urinate that may be difficult to control
Prevalence of urinary incontinence/OAB
OAB is higher than UUI
SUI is most common incontinence compared to UUI
3 factors of risk factor
Obs and gyn.
Predisposing
Promoting
O and G risk factors
Pregnancy and childbirth
Pelvic surgery/DXT
Pelvic prolapse
Predisposing risk factors
Family predisposition
Race
Anatomical abnormalities
Neurological abnormalities
Promoting risk factors
Co-morbidities
Obesity
Age
Increased intra abdominal pressure
Cognitive impairment
UTI
Drugs
Menopause
3 classes of classification for lower urinary tract symptoms
Storage, voiding, post-micturition
What do we need to rule out
Diabetes
Storage symptoms of LUTs
Increased frequency
Urgency
Nocturia
Incontinence
Voiding symptoms of LUTs
Slow stream
Splitting or spraying
Intermittency
Hesitancy
Straining
Terminal dribble
Post-micturition LUTs
Post micturition dribble
Feeling of incomplete emptying
Additional factors to consider when determining type of UI
Fluid intake habits, particularly tea and coffee
Previous pelvic surgery
History of large babies
Symptoms of uterovaginal prolapse and faecal incontinence
Examinations needed when investigating for Urinary incontinence
-BMI
-Abdo exam to exclude palpable bladder
-Examination of S2,3,4 dermatomes if suspecting neurological disease
-Digital rectal examination DRE (prostate if male)
- Females external genitalia (stress test), vaginal exam
Investigations for urinary incontinence
Mandatory- urine dipstick, UTI, haematuria, proteinuria, glucosuria
Basic non-invasive urodynamics- frequency-volume chart, bladder diary over 3 days, post micturition Residual volume (in patients with voiding dysfunction)
Optional- invasive urodynamics (pressure flow studies and or video), pad tests, cystoscopy
Conservative management of urinary incontinence
Modify fluid intake
Weight loss
Stop smoking
Decrease caffeine intake (UUI)
Avoid constipation
Timed voiding- fixed schedule
Contained incontinence systems
For patients unsuitable for surgery who have failed conservative or medical management
Indwelling catheter- urethral or suprapubic
Sheath device- analogous to an adhesive condom attached to catheter tubing and bag
incontinence pads
Specific management of SUI
Pelvic floor muscle training (PFMT)
- 8 x contractions (x3 a day)
- 3 months duration at least
Duloxetine
Features of Duloxetine
Combined noradrenaline and serotonin uptake inhibitor
Increased activity in the striated sphincter during filling phase
Not recommended by NICE as first line or routine second line treatment but may be offered as alternative to surgery
Surgery in females for SUI
Permanent intention
- open retropubic suspension procedures
- classical autologous sling procedures
- low tension vaginal tapes
Temporary if further pregnancies planned
- Intramural bulking agents
