Flashcards in Urinary incontinence Deck (38):
What is urinary incontinence?
Involuntary leakage of urine
Urinary incontinence is common. T/F
Which sex experiences urinary incontinence more commonly?
List the types of urinary incontinence
By which two means might urine leak extra-urethrally?
Explain the normal micturition cycle
Storage phase - intravesical pressure lower than intraurethral pressure so urine stays in bladder
Voiding phase - detrusor contracts increasing intravesical pressure above intraurethral pressure causing relaxation of sphincters and micturition
What affects intravesical pressure?
Abdominal pressure (coughing, sneezing, etc)
What is urodynamics?
An invasive test measuring pressure within the bladder and abdominal cavity and detrusor muscle pressure
How is a urodynamic test carried out?
Pressure sensor in bladder
Pressure sensor in rectum
Ask patient to cough three times - each time with more force
What are the components of the micturition reflex?
Spinal bladder centre (S2-3)
Which nerves are involved in the micturition reflex?
Pelvic parasympathetics (bladder & internal sphincter)
Pudendal (external sphincter)
The micturition reflex is inhibited and facilitated by descending controls from the brain. T/F
What causes overflow incontinence?
How does overflow incontinence present?
Huge palpable bladder
Insensible incontinence (only aware after feeling wetness)
Renal impairment (due to back pressure of urine)
What causes urge incontinence?
How does urge syndrome present?
Small volumes of urine
Urgency (provoked by sounds, standing, coughing, laughing, sneezing)
What is detrusor overactivity?
Contraction of detrusor during inhibition of micturition
How is detrusor overactivity diagnosed?
What causes detrusor overactivity?
Afferent overstimulation (stone, tumour)
Excess central facilitation (anxiety)
Paraplegia (loss of central inhibition)
Destruction of bladder centre (S2-3) - inert bag bladder
Pelvic surgery/fracture --> parasympathetic nerve damage
What is damage to parasympathetic nerves associated with?
Higher risk of infection
What nerve is not affected when parasympathetic nerves are damaged?
How does idiopathic detrusor overactivity usually present?
What is (urodynamic) stress incontinence?
Leakage of urine during increased intra abdominal pressure WITHOUT detrusor contraction
What causes stress incontinence?
Damage to pelvic floor
Damage to urethral function
i.e child birth
How is stress incontinence diagnosed?
When might frequency occur with stress incontinence? Which symptom should not be present?
As a learned behaviour to try and prevent/reduce incontinence
How should the bladder feel on examination (if it is full)?
Painless mass arising from pelvis
Cannot "get below it"
Dull to percussion
Nb - in female patients it could be pregnancy
How is overflow urinary incontinence treated?
Assessment of renal function
Catheterisation to treat obstruction
Rehabilitation of bladder (teach how to self catheterise)
How is urge urinary incontinence treated?
Timing of bladder emptying
Which pharmacological options are available in the treatment of urge incontinence? What are the side effects?
Anti-muscarinics e.g oxybutinin, tolterodine (dry mouth)
Beta 3 adrenergic i.e mirabegron
How is stress incontinence treated?
Physiotherapy (pelvic floor exercises)
Pharmacotherapy (not useful)
Surgery (open vs tape)
How is mixed incontinence treated?
Combination urge and stress treatment approach
What are risk factors for urinary incontinence in the elderly?
Drugs (diuretics, sedatives)
Obstruction --> overflow
Weak pelvic floor
Ectopic ureters are congenital. T/F
What is the cause of most vesico-vaginal fistula?
Prolonged obstructed labour
What is urgency?
Sudden, compelling desire to pass urine
List some voiding symptoms
Abnormal stream (splitting)