Urinary Incontinence Flashcards Preview

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Flashcards in Urinary Incontinence Deck (14):
1

What are the causes of incontinence?

- Stress incontinence: defects in pelvic floor / urethral sphincter deficiency.
- Urge incontinence: detrusor overactivity / neurological incoordination
- Overflow incontinence
- Fistulae
- Congenital
- Urethral diverticulum
- Other (UTI, faecal impaction, medication, immobility)

2

Hx to elicit in incontinence evaluaton?

- Leakage episodes
- Pad usage
- QoL questionairres
- Oral fluid intake (water, caffeine, alcohol)
- Prolapse symptoms
- Dysuria
- Painful bladder filling
- Haematuria
- Bowel symptoms (faecal incontinence, constipation)
- OHx, GHx
- PMAFOST

3

What medications should be asked for on history in incontinence evaluation?

- anti cholinergics
- diuretics
- anti hypertensives

4

Ix in incontinence evaluation?

- MSU
- PVR
- Bladder diary
- QoL questionairres
- Urodynamics / videourodynamics
- Cystourethroscopy

5

What is stress incontinence?

Involuntary leakage of urine with exertion

6

What causes stress incontinence?

- Increased IAP (pregnancy, cough, abdo mass, constipation, obesity)
- Damage to pelvic floor (pregnancy, delivery, surgery)
-Failure of intrinsic sphincter (trauma, reduced collagen)

7

Conservative Mx stress incontinence?

-Pelvic floor exercises
- biofeedback
- electrical stimulation
- pads
- incontinence pessary

8

Surgical management of stress incontinence?

Surgical: always trial conservative first, urodynamics performed before surgery.
- Burch colposuspension
- Peri urethral bulking agent injections

9

What are the types of urge incontinence?

- Overactive Bladder Syndrome: symptoms of urinary urgency, frequency and nocturia with or without urge incontinence

- Detrusor Overactivity

10

How is detrusor overactivity defined?

Urodynamic observation characterised by involuntary detrusor contractions during the filling phase which may be spontaneous or provoked.

11

Aetiology urge incontinence?

- Idiopathic
- Psychosomatic
- Neuropathic
- Complications of incontinence surgery
- Outflow obstruction
- Bladder pathology (stones, cancer)

12

Pathophysiology of urge incontinence?

Varies according to aetiology; common theme is change in property of detrusor smooth muscle predisposing bladder to unstable contractions

13

Mx urge incontinence?

- FR under 1.5L
- Restrict alcohol, caffeine
- Bladder retraining with PT
- Pharm: ACh
- Surg: botox

14

What is the MoA of anticholinergics used for OAB?

Anticholinergics: ACh released from postganglionic parasympathetic nerve terminals. Acts on muscarinic receptors in detrusor to initiate bladder contraction.
Oxybutynin, tolterodine, solifenacin, darifenacin