Urinary incontinence Flashcards
(23 cards)
What is urinary incontinence?
Loss of control of urination
What is urge incontinence?
Overactivity of detrusor muscle of bladder
Pt will describe suddenly feeling urge to pass urine, having to rush to bathroom and not arriving before urination occurs.
What impact does urge incontinence have on quality of life?
Significantly impacts it as women will be conscious of having easy access to a toilet at all times.
What is stress incontinence?
When pelvic floor and sphincter muscles weaken, allowing urine to leak at times of increased pressure on bladder
eg. when coughing or laughing.
Why does pelvic floor weaken?
It consists of a sling of muscles which support the pelvis and there are 3 canals: urethral, vaginal & rectal. If muscles of pelvic floor are weak, the canals become lax and organs are poorly supported within the pelvis.
What is mixed incontinence?
A combination of urge and stress incontinence. Identify which is causing the most significant impact and address that first.
What is overflow incontinence?
Occurs when there is chronic urinary retention due to obstruction to outflow of urine. Chronic urinary retention results in an overflow of urine and incontinence occurs without the urge to pass urine.
When does overflow incontinence happen?
Anticholinergic meds, fibroids, pelvic tumours, neuro conditions eg MS or diabetic neuropathy.
What are modifiable risk factors?
Caffeine consumption, alcohol consumption, meds, BMI.
How can you assess severity?
Frequency of urination, frequency of incontinence, urethral diverticulum, pelvic masses.
How do you assess strength of pelvic floor?
During bimanual examination by asking woman to squeeze against examining fingers.
What is used to grade strength of pelvic floor?
modified Oxford grading system.
What is the grading for the Oxford grading system?
0 = no contraction
1 = faint contraction
2 = weak contraction
3 = moderate contraction with some resistance
4 = good contraction with resistance
5 = strong contraction, firm squeeze drawing inwards.
What investigations are done?
- Bladder diary over at least 3 days
- Urine dipstick testing - infection
- Post-void residual bladder volume
- Urodynamic testing for urge incontinence - only required if history and exam can’t give diagnosis.
How do you do urodynamic testing?
A thin catheter is inserted into the bladder and another into the rectum. They measure the pressures in the bladder & rectum for comparison - the bladder is filled with liquid and various outcome measures are taken.
What types of urodynamic testing are there?
- Cystometry → measures detrusor contraction & pressure
- Uroflowmetry → measures flow rate
- Leak point pressure → point at which bladder pressure results in leakage of urine
- Post void residual bladder volume
- Video urodynamic testing → filling bladder with contrast and taking X Rays of bladder as emptied.
How do you manage stress incontinence before surgery?
Avoid caffeine, diuretics, avoid excessive fluid intake, weight loss, supervised pelvic floor exercises, Duloxetine - SNRI antidepressant.
What are surgical managements of stress incontinence?
- Tension free vaginal tape → mesh sling looped under urethra and behind pubic symphysis to support urethra and reduce stress incontinence.
- Autologous sling procedures → strip of fascia from pt’s abdominal wall is used rather than tape
- Colposuspension → stitches connecting the anterior vaginal wall & pubic symphysis around urethra, pulling vaginal wall forwards and adding support to urethra
- Intramural urethral bulking involves injections around urethra to reduce the diameter and add support.
What is the management of urge incontinence?
Bladder retraining, anticholinergic medication, Mirabegron, invasive procedures, if troublesome nocturne, desmopressin may be considered.
What are side effects of anticholinergics?
dry mouth, dry eyes, urinary retention, constipation & postural hypotension. Can lead to cognitive decline and worsening of dementia in older pts.
What is an alternative to anticholinergics?
Mirabegron but this is contraindicated in uncontrolled hypertension so bp needs to be monitored regularly.
How does mirabegron work?
beta 3 agonist which stimulates sympathetic nervous system leading to raised blood pressure → hypertensive crisis and increases risk of TIA and stroke.
What are invasive options for overactive bladder?
Botulinum toxin type A injection into bladder wall, percutaneous sacral nerve stimulation where you implant a device into back and stimulate sacral nerves, augmentation cystoplasty → bowel tissue to enlarge bladder, urinary diversion → redirect flow to urostomy on abdomen.
