Urinary Incontinence Flashcards
(25 cards)
Urinary incontinence
Involuntary leakage of urine
Types of incontinence
Urge incontinence
Stress incontinence
Mixed incontinence
Overflow incontinence
Functional incontinence
Urge incontinence
Overactive bladder or infection causes involuntary contractions of bladder muscles
-> Sudden compelling desire to pass urine that is difficult to defer
- Usually idiopathic
- No warning before incontinence episodes
- A/w increased urinary frequency
Stress incontinence
Involuntary loss of urine due to:
- Increase in intrabdominal pressure
- Weak pelvic floor muscles
-> urethra too weak to stay closed
Mixed incontinence
Mix of urge and stress incontinence
*Determine predominant sx
Overflow incontinence
Associated with incomplete emptying of bladder due to:
- Underlying systemic neurological disease
- Chronic obstruction of bladder neck
“Continuous dribbling with a full bladder that is unable to empty completely “
What type of incontinence is more common in women?
Stress incontinence
Risk factors of stress urinary incontinence
Think: weakened pelvic floor muscles
1. Pregnancy >20 weeks ++ (full term?)
2. Increase number of parity
3. Vaginal delivery (assisted/instrumental, weight of baby)
4. Congenital/ Genetic (FHx of prolapse)
- Ehler Danlos, Marfans
5. Aging/ Menopause
6. Chronic raised intra-abdominal pressure
- Obesity
- COPD/Asthma, chronic cough
- Smoking
- Chronic constipation
- Occupations requiring manual labour (Avoid carrying >5kg)
7. Previous pelvic surgery
++ 8. Uncontrolled DM - polyuria, polydipsia
++ 9. Hx or current POP
How does increasing age increase risk of SUI / Why is SUI more prevalent in menopausal women?
As women’s age increases / In menopausal women:
- Lack of estrogen causes vaginal dryness, bladder sensitivity and pelvic muscle weakening
- Shorter urethra -> increased risk of urinary incontinence
History taking points for urinary incontinence
Type of incontinence
Screen RFs
Possible POP
Excessive fluid intake > 2L
Medications eg diuretics
Caffeine (diuretic) intake
Impact on QOL: how bothered are you by symptoms?
Physical examination for urinary incontinence
General:
- BMI, Obesity
Abdominal PE:
- Previous scars
- Abdominal distension/ masses
- Tenderness
Pelvic PE:
- Bedside stress urinary incontinence (Ask patient to cough)
- Pelvic floor tone via digital assessment
+/- anal tone
IF there is POP -> do Pop-Q and look for:
- Vulva: Excoriations/ previous scars
- Atrophic vaginitis (pale, loss of ruggae)
- Ulcerations/ erosions
- Bleeding/ abnormal vaginal discharge
Investigations of urinary incontinence
Urine tests
- UFEME, urine culture TRO UTI
- Check post void residual urine
(normal <100ml, for older patients <150ml)
- Urodynamics
- Bladder diary
Diagnostic test for UI
Urodynamic studies: measures pressure within bladder and abdomen during bladder filling and emptying to determine likely cause of LUTS
C/I of urodynamics studies
UTI - Do urine dipstick to TRO
Treatment of stress incontinence
- Lifestyle modifications
- Pelvic floor exercises
- Bladder training
- Pessaries (incontinence ring or dish) IF there is an existing prolapse
- SURGERY
Treatment of urge incontinence
1st line
- Lifestyle modifications
- Pelvic floor exercises (refer to PT)
- Bladder training (refer to PT)
2nd line
- MEDICATIONS
- Non-invasive procedures
Lifestyle interventions
- Weight loss
- Avoid smoking
- Avoid constipation
- Avoid prolonged coughing/standing
- Avoid carrying heavy things
- Control medical conditions (COPD, Asthma, DM)
& - Less coffee, carbonated drinks, alcohol
- Frequent small fluid intake rather than large episodic intakes ~1.5L/day
- Regular timed voiding
Bladder training
REFER TO PHYSIOTHERAPIST
Patients taught to void regularly by the hour -> trains the mind to not go so often:
If have to void <1h before next void:
- Sit and contract pelvic floor muscles for 1-2mins
- Keep pelvic floor contracted and walk slowly to toilet
- Gradually increase interval by 5-15mins until satisfied with voiding frequency
Surgical options for SUI
Midurethral slings
- Compresses urethra to aid in urethral closure mechanism during increase in intra-abdominal pressure
- Pros: fast, good improvement rates, minimally invasive
“Synthetic tape inserted under vaginal skin to support the urethra”
Types of midurethal slings
- Retropubic tape
- higher risk of bladder perf
- high risk of retained urine - Transobturator tape
- higher risk of neurological sx
Medications for urge incontinence
*2nd line therapy after lifestyle intervention and pelvic floor exercises
ANTICHOLINERGICS
- blocks Ach from binding to muscarinic receptors in smooth muscle of bladder
- prevents muscle fibre contraction
or BETA BLOCKERS (mirabegron)
Side effects of anticholinergics
Impaired cognition
Blurred vision
Dry mouth
Palpitations
Gastric reflux
Constipation
Urinary retention
*discontinuation common due to adverse S/E
C/I of anticholinergics
Narrow angle glaucoma
Cardiac arrythmias
Examples of anticholinergics
Oxybutynin, tolterodine, solifenacin (Vesicare), trospium, darifenacin, fesoterodine
