Urinary Incontinence Flashcards
(42 cards)
1
Q
What are the characteristics of the UUT
A
- Kidney & ureters
- A low-pressure distensible conduit with intrinsic peristalsis
- Transport urine from nephrons via ureters to the bladder
2
Q
Characteristics of the LUT
A
- Bladder and urethra
- Low-pressure storage
- Efficient expulsion of urine at appropriate place & time
3
Q
What is the vesico-ureteric mechanism
A
- Protects the nephrons from any damage secondary to retrograde transmission of back pressure or infection from the bladder
- Vesico-ureteric valve only allows flow 1 way
4
Q
What is the length of the urethra (male and female)
A
- Women - 4cm
- Men - 25cm
5
Q
What is the nerve supply of the bladder
A
- Storage - hypogastric nerve - T10-L2 (sympathetic) (s for storage)
- Voiding - pelvic nerve - S2-4 (parasympathetic)
- Voluntary - pudendal nerve - S2-4 (somatic)
6
Q
Why are women more prone to bladder leakage
A
- The prostate aids voluntary control in men
7
Q
What are the characteristics of bladder filling
A
- Accomodate increasing volume at constantly low pressure
- Inhibition of contractions by giving rise to gradual awareness of filling
8
Q
What is the cortical activity of bladder filling
A
- Activating reciprocal guarding reflex by Rhabdosphincter contraction
- Increase sphincter contraction & resistance
- Activates sympathetic pathway
- Reciprocal inhibition of the parasympathetic pathway
- Mediates contraction of bladder base and proximal urethra
9
Q
What is normal bladder capacity
A
- 400-600ml (1 pint)
- 125ml (1/4 pint) first sensation
- 250ml (1/2 pint) start to feel the need but not desperate
- 500ml (1 pint) need to go - max systemic capacity
10
Q
How does bladder emptying occur
A
- Detrusor contraction
- Urethral relaxation
- Sphincter co-ordination
- Absence of obstruction or anatomical shunts (cystocele, diverticulum)
- Cortical influence (pontine micturatioon centre) –> activation of parasympathetic oathway & inhibition of sympathetic pathway
- E.g. convienient location
11
Q
What is urinary incontinence
A
- Any involuntary leakage of urine
12
Q
What is stress urinary incontinence
A
- Involuntary leakage on effort or exertion, on sneezing or coughing
13
Q
What is urge incontinence
A
- Involuntary leakage accompanied by or immediately preceded by urgency
14
Q
What is mixed urinary incontinence
A
- Involuntary leakage accompanied by or immediately preceded by urgency & on effort pr exertion, or on sneezing or coughing
15
Q
What is the epidemiology of urinary incontinence
A
- 10-25% of women age 15-60
- 15-40% women >60
- >50% women in nursing homes
16
Q
What is the impact of urinary incontinence
A
- Impairs QoL
- Reduces social relationships and activities
- Impairs emotional and psychological well-being
- Impairs sexual relationships
- Embarrassment and diminished self-esteem
- Average length of suffering - 5 years
17
Q
Risk factors of urinary incontinence
A
- Age
- Parity - pregnancy main risk factor
- Menopause
- Smoking
- Medical problems
- Increased intraabdominal pressure
- Pelvic floor trauma
- Denervation
- Connective tissue disease
- Surgery
- Instrumental delivery
18
Q
Theory of female urinary incontinence
A
- Both stress and urge incontinence arise from the same anatomical defect in the anterior vaginal wall and pubo-urethral ligament (PUL)
- Urethral/bladder neck closure dysfunction and USK
- Suburethral hammock laxity might result in stimulation of bladder neck stretch receptors, provoking a premature micturation rllfex and urgency incontinence
19
Q
How are patients with urinary incontinence assessed
A
- History
- Examination
- Investigations
- Management
20
Q
What is important in the history of UI
A
- Age, parity, mode of deliveries, weight of heaviest baby, smoking, HRT
- Medical problems
- DM (causes polyuria), anti-HTN medications dioxide relaxes urethra, reduce furosemide) glaucoma (cannot have urgency medication), heart/kidney/liver problems, cognitive problems antidepressants/anti-psychotics (anti-cholinergics)
- Previous PFMT, surgical treatment of SUI or POP
21
Q
What is normal frequency
A
- Urge is normal, urgency is not
- Daytime frequency - 7
- Nocturia - 1
- Number increase by 1 each decade after 60
22
Q
What irritation symptoms for patients complain of
A
- Urgency; sudden compelling desire to void that is difficult to defer
- Increased daytime frequency (>7)
- Nocturia (>1)
- Dysuria
- Haematuria
23
Q
What incontinence symptoms do patients complain of
A
- Stress UI
- Urhency UI
- Coital incontinence
- Severity - pads/day
24
Q
What voiding symptoms do patients complain of
A
- Straining to void
- Interrupted flow
- Recurrent UTI
25
What other symptoms need to be asked about in the history of UI
* Fluid intake: quantity and quality
* Effect on QoL - scale 1-10
* Prolapse symptoms
* Vaginal lump/dragging sensation in vagina
* Bowel symptoms
* Anal incontinence, constipation, faecal evacuation dysfunction, IBS
26
What should be done before the clinic of UI
* £ day urinary diary
* Fluid intake: quantity and quality
* Urine out-put (exclude nocturnal polyuria)
* Day-time frequency
* Nocturia
* Average voided volume
* Can show if SUI or UUI
* Urine dipstick
27
What examination should be done in UI
* General
* Abdominal Neurological
* Gynaecological
* Pelvic floor assessment (Oxford scale)
28
What should be looked at those with UI and bladder/pelvic floor problems
* Prolapse
* Stress incontinence
* Uro-genital atrophy changes
* Pelvic mass (space-occupying lesion)
* Pelvic floor tone, strength, awareness
29
What investigations in UI
* Urinalysis
* Multistix +/- MSSU
* Post voiding residual volume assessment
* Usually bladder scanning
* Only symptoms of voiding difficulties
* Urodynamic - only indicated if surgical treatment contemplated
* Uroflowmetry
* Multi-channel cytometry
30
What is the general management of UI
* Lifestyle changes - e.g. reduce intake, lose weight (\>30), reduce caffeine, avoid chocolate, avoid fizzy drinks, avoid sugar/sweeteners
* Medica treatments
* Physio
* Surgery
31
What is the management of stress urinary incontinence
* Urethral closure pressure increased by
* Pelvic floor muscle training
* Surgery
* Pharmacological agents
32
Lifestyle changes for treatment of UI
* Stop smoking
* Lose weight
* Eat more healthily to avoid constipation
* Stop drinking alcohol and caffeine
33
What is the conservative treatment of UI
* Should be used on everyone (unless previously failed)
* Pelvic floor muscle training
* Reinforcement of cortical awareness of muscle groups
* Hypertrophy of existing muscle fibres
* General increase in muscle tone and strength
34
Pharmacological treatment of UI
* Yentreve (duloxetine)
* Moderate to severe stress UI
* Adjuvant to exercises
* Can cause nausea
35
Surgical management of UI
* Colosuspension
* Lifting the urethra back up
* Mid-urethral slings retro-pubic TVT
* Tension-free vaginal tape (TVT) was introduced as minimally invasive procedure to reinforce structures
* 80% cure at 11-years follow up
* Problem with foreign body
36
What is overactive bladder syndrome
* Symptoms complex usually related to urodynamically demonstrable detrusor overactivity
* Symptoms syndrome - not easy to diagnose
37
Symptoms of overactive bladder syndrome
* Urgency (with/without incontinence)
* Usually with frequency and nocturia
38
What are the risk factors for overactive bladder syndrome
* Advanced age
* Diabetes
* UTIs
* Smoking
39
Treatment of overactive bladder syndrome
* Treat symptoms
* No immediate cure
* MD approach
* Lifestyle
* Bladder training
* Pharmacological
40
Lifestyle changes as management of overactive bladder syndrome
* Normalise fluid intake
* Reduce caffeine, fizzy drinks, chocolate
* Stop smoking
* Weight loss
41
What is the bladder training programme in overactive bladder syndrome management
* Timed voiding with gradually increasing intervals - continence nurse
42
Pharmacological treatments of overactive bladder syndrome
* Antimuscarinic
* Oral
* Solifenacin
* Fesoteridine
* Trospium chloride
* Darifenacin
* Lyrical XL
* Oxybutynin
* Transdermal
* Kentera patches
* Tricyclics
* Botox
* Neuromodulation
