Urinary incontinence Flashcards
Risk factors
Advancing age
Previous pregnancy and childbirth
High BMI
Hysterectomy
Family history
Neurological conditions (MS)
Pelvic floor surgery
Pelvic organ prolapse
Urge incontinence
Overactivity of the detrusor muscle of the bladder (also known as overactive bladder)
Urge to urinate quickly followed by incontrollable leakage
Stress incontinence
Weak pelvic floor muscles so organs poorly supported
Urine leaks at times of increased pressure on the bladder
When laughing, coughing, surprised
Overflow incontinence
Due to bladder outlet obstruction e.g. prostate enlargement, fibroids, pelvic tumours
More common in men
Women with overflow incontinence need urodynamic testing
Modifiable lifestyle factors
Caffeine consumption
Alcohol consumption
Medications
BMI
Investigation
Bladder diary
Urine dipstick
Post-void residual bladder volume
Urodynamic testing when urge incontinence not responding to first-line treatments/ difficulties urinating/ retention/ previous surgery/ unclear diagnosis
Urodynamic studies
Thin catheter inserted into the bladder and another into the rectum
Catheters measure the pressures in the bladder and rectum for comparison
Bladder is filled with liquid and various outcome measures are taken
Management of stress incontinence
Conservative: avoid caffeine, diuretics and overfilling the bladder; avoid excessive or restricted fluid intake; weight loss
Supervised pelvic floor exercises
Surgery
Duloxetine
Surgical options for stress incontinence
Tension free vaginal tape
Autologous sling procedures
Colposuspension
Intramural urethral bulking
Management of urge incontinence
Bladder retraining
Anticholinergics- oxybutynin, tolterodine, solifenacin
Mirabegron (alternative to anticholinergics)
Side effects of anticholinergics
Dry mouth
Urinary retention
Constipation
Postural hypotension
Cognitive decline, memory problems, worsening of dementia
Mirabegron
Contraindicated in uncontrolled HTN
Blood pressure needs to be monitored regularly
Stimulates sympathetic nervous system leading to raised BP
Can cause hypertensive crisis
Increased risk of TIA and stroke
Invasive options for urge incontinence
Botulinum toxin type A
Percutaneous sacral nerve stimulation
Augmentation cystoplasty
Urinary diversion
