Urinary Incontinence Flashcards
(17 cards)
Types of urinary incontinence
Stress Urge Mixed Overflow Functional
Risk factors for UI
Childbirth Pelvic surgery Prolapse Menopausal BPH Obesity Smoking Chronic cough Constipation Cognitive decline/immobile for functional Diabetes UTI High alcohol intake High caffeine intake
Assessment of pelvic floor strength
Oxford classification: 0 - no contraction 1 - flicker 2 - weak 3 - moderate 4 - good 5 - strong
Examination for urinary incontinence
BMI External genitalia - prolapse (with sims speculum), pelvic floor strength, cough/strain test Percuss for distended bladder Neuro examination lower limbs DRE for males to assess prostate size Cognitive screening
Investigations for urinary incontinence
Urine dipstick
Patient completed frequency volume chart
Urodynamics - pressure flow graph
Post micturition bladder USS
Lifestyle management of urinary incontinence
Weight loss Smoking cessation Decrease alcohol and caffeine intake Stop drinking in evenings Pelvic floor exercises Bladder training by voiding schedule Treat constipation
Specific management of stress UI
Mid urethral fascial sling
No tension vaginal tape
Intramural bulking agent as temporary solution if want more children
Specific management of urge UI
1st line: M3 antagonist - oxybutynin 2nd line: B3 agonist - mirabegron 3rd line (refer at this stage): Botulinum toxin injection to inhibit ACh release 4th line: Sacral nerve neurostimulation
Oestrogen pessary if atrophic vaginitis with UI
Specific management of BPH
Doxazocin (alpha 1 antagonist)
Finasteride (5 alpha reductase inhibitor)
Transurethral resection of the prostate
Specific management of non BPH overflow UI
Rule out reversible causes
Post voiding bladder scan
Intermittent self catheterisation
Management of functional UI
PT/OT Refer to social care Medication review Continence aids Asses mobility
What causes incontinence associated dermatitis
Double incontinence - bacteria in faeces converts urea to ammonia which damages normal flora and causes dermatitis
Continence products available from continence nurses
Incontinence pads Beambridge products (collecting system - don't need access to toilet) Convene - condom catheter
Impact of incontinence
Socially withdrawn Mental health Financial Job Self esteem
Clinical indications for bladder scan
Confirm urinary retention
Confirm incomplete bladder emptying
Monitor urinary retention following TWOC
Abnormal post micturition bladder scan results with respective management
> 150 ml:
Stop any anticholingerics
Repeat in 4 weeks
If persistent refer to continence services
> 600 ml:
Report to urology doctor on call
How is a post micturition bladder scan performed
Performed immediately after patient has tried to pass urine
Scan suprapubic area with patient supine
Need to set US for male or female
Take 3 readings
