Urinary Incontinence Flashcards
What are the three types of incontinence?
Overflow incontinence
Stress incontinence
Urge incontinence- Also overactive bladder
What are the features of overflow incontinence?
Occurs when there is urinary outlflow obstruction which causes urinary retention. Increasing volumes in the bladder cause triggering of the stretch reflex which results in voiding.
What cause overflow incontinence?
Bladder outflow obstruction
E.g. BPH, Strictures, Malignancy, Prostate cancer
What are the features of stress incontinence?
Stress incontinence is when there is urination when there are increases in intra-abdominal pressure such as with coughing or laughing. This occurs due to incompetent sphincter and pelvic floor weakness
When is stress incontinence common?
After childbirth due to disruption of the pelvic floor musculature
Also occurs with increasing age and obesity
What are the features of urge incontinence?
Urge to urinate is quickly followed by uncontrollable and sometimes complete bladder emptying. Due to detrusor overactivity- also called overactive bladder.
What causes urge incontinence?
Issues with central pathways or peripheral afferents
Infection
Diabetes
What investigations should be done for urinary incontinence?
Depends upon the cause
Patient Assessment
IPSS in men
QoL Assessment in women
Examination Palpate/Percuss Bladder DRE in men Sensation in saddle area Check anal tone Vaginal examination- Check pelvic floor contraction Neurological examination- MS
Urine-
Dipstick
MSU
Urodynamic studies
Post micturition volume assessment (via bladder scan or catheter)
Bladder diary- record fluid intake and urine output
Blood-
FBC, Infective markers
PSA in men (BPH can cause prostatic hypertrophy)
What lifestyle changes can you recommend to patients with urge and stress incontinence?
Decrease alcohol and caffeine intake
Lose weight if appropriate
What conservative methods may be used to manage urge and stress incontinence?
Less caffeine and alcohol, weight loss
Pelvic floor training
Behavioural therapies
Pads
Bladder retraining
What medical options may be used in the treatment of urge incontinence?
Antimuscarinics e.g. Oxybutynin, Tolterodine
Beta 3 Agonist- Mirabegron (If antimuscarinics not suitable or not working)
Desmopressin- for nocturia, it is an ADH analogue
Give an example of a beta 3 agonist?
Mirabegron
Give an example of antimuscarinic used in the management of urge incontinence?
Oxybutynin
Tolterodine
Note- Immediate release oxybutynin should be avoided in frail older women
What invasive procedures might be used in the management of urge incontinence?
Botox injection into bladder wall- if not responded to pharmacological treatment. Must be able to perform intermittent self catheterisation.
Percutaneous posterior tibial nerve stimulation- if botox injections not wanted or self catheterisation not possible
What surgical procedures may be considered for the management of urge incontinence?
Synthetic tapes to support the urethra to increase resistance to flow
Bulking agents around the urethra,
