Urinary incontinence Flashcards
What is the usual patient description for urge incontinence?
- sudden, strong need to urinate
- not making it to the toilet in time sometimes
- occurs in the day and the night
- no incontinence on exertion e.g. sneezing, coughing
What is the patient description of stress incontinence?
leaking when exerting themselves e.g. coughing, sneezing, jumping, running
usually after childbirth
First line management for stress incontinence
Pelvic floor training:
NICE recommend at least 8 contractions performed 3 times per day for a minimum of 3 months
First line management for urge incontinence
Bladder retraining (can take up to 6 weeks)
What is the mechanism behind urge incontinence?
overactivity of the detrusor muscle, causing uninhibited and inappropriate contractions of the bladder
What is the name of the surgical procedure that is performed for stress incontinence?
retropubic mid-urethral tape procedures
What medication is offered for patients who decline surgical intervention for stress incontinence?
Duloxetine (SNRI)
Mechanism of action:
1. increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve
2. increased stimulation of urethral striated muscles within the sphincter
3. enhanced
contraction of the bladder
What surgical procedure is performed for treatment of vaginal vault prolapse?
Sacrocolpopexy.
This procedure suspends the vaginal apex to the sacral promontory.
What are the risk factors for urogential prolapse?
- increasing age
- multiparity, vaginal deliveries
- obesity
- spina bifida
Presentation of urogenital prolapse
- sensation of pressure, heaviness, ‘bearing-down’
- urinary symptoms: incontinence, frequency, urgency
Name 3 types of urogenital prolapse
cystocele
rectocele
uterine prolapse
What is the differential diagnosis in a patient who has continuous dribbling after child birth?
Vesicovaginal fistula - abnormal opening between the bladder and the vagina
