What is urinary incontinence?
the complaint of any
involuntary leakage of urine.
What is stress incontinence
Stress urinary incontinence is involuntary leakage on
effort or exertion, or on sneezing or coughing.
What is urge incontinence
Urgency urinary incontinence is involuntary leakage
accompanied by, or immediately preceded by
urgency.
What is urgency
Urgency is the complaint of a sudden compelling
desire to pass urine, which is difficult to defer
What is urgency
Urgency is the complaint of a sudden compelling
desire to pass urine, which is difficult to defer
What is overactive bladder syndrome/urge syndrome
Urgency, with or without urge incontinence, usually with
frequency and nocturia, can be described as overactive bladder
syndrome, urge syndrome or urgency-frequency syndrome.
What is mixed urinary incontinence
Mixed urinary incontinence is involuntary leakage associated
with urgency and also with exertion- effort, sneezing or
coughing.
What is a frequency volume chart
frequency volume chart (FVC) records the volumes voided as
well as the time of each micturition, day and night for at least 24 hrs
What is a frequency volume chart
frequency volume chart (FVC) records the volumes voided as
well as the time of each micturition, day and night for at least 24 hrs
What gender is urinary incontinence more common in
women
How may urine leak in an extra urethral route
ectopic ureter
fistula
What effect does increased intrabdominal and intravesicla pressure have on detrusor pressure
no effect
What spinal nerve routs give rise to the nerves that contol the bladder
s2 and 3
What spinal nerve routs give rise to the nerves that contol the bladder
S2 and 3
What are the symptoms of overflow incontinence
Bladder outflow obstruction
Huge palpable bladder
chronic retention
wet at night
What are the symptoms or urge incontinence
Frequency
Urgency
Enuresis
What may be a ‘trigger’ for urgency in urge incontinence
key in door
running water
standing up
coughing laughing
What is thought to be a mechanism for urge incontinence
detrusor overactivity
how is detrusor overactivity diagnosed
urodynamics
what else may cause urge incontinence
paraplegia (loss of central inhibition)
excess central facilitation
destruction of S2/3
what else may cause urge incontinence
paraplegia (loss of central inhibition)
excess central facilitation
destruction of S2/3
pelvic surgery - parasympathetic nerve damage
what else may cause urge incontinence
paraplegia (loss of central inhibition) excess central facilitation destruction of S2/3 pelvic surgery - parasympathetic nerve damage idiopathic
what characterises stress incontinence
Urine leaks during increased intra abdominal pressure, without a detrusor contraction Due to damage to pelvic floor or urethral function - childbirth
how is stress incontinence diagnosed
urodynamics
how do you when the mass you are feeling is a bladder
Painless palpable mass arising from pelvis •Cannot “get below” it •Dull to percussion =overflow incontinence bladder
how do you treat overflow incontinence
Assess renal function Treat the obstruction Catheterise rehabilitate the bladder Teach intermittent self catheterisation
How do you treat urge incontinence
Dietary discretion (avoid caffeine)
Biofeedback
Bladder retraining, Time bladder emptying
Pharmacotherapy
Antimuscarinics - (e.g. oxybutynin, tolterodine)
Beta 3 adrenergics (mirabegron)
Botulinum toxin injection – unlicenced
Neuromodulation (“pacemaker” for the bladder)
Surgery
Enterocystoplasty
how do you treat stress incontinence
Weight loss Stop smoking! Pelvic floor exercises - physiotherapy Pharmacotherapy – (not very much role) Duloxetine (serotonin (5-HT) and norepinephrine (NE) reuptake inhibitor) Surgical correction Open procedures – colposuspension largely replaced by: Minimally invasive “tape” procedures
what causes a vesico vaginal fistula
prolonged obstructed labour