Urinary Incontinence Flashcards
(31 cards)
Define urinary incontinence?
The complaint of any involuntary leakage of urine
Urinary incontinence is more common in men or women?
Women
Urine can leak from the _1___ or __2___ route
___3_____ is most common and split into 4 categories which are _____4______
1) urethral
2) extra-urethral
3) urethral
4) overflow, urge, stress or mixed
Define overflow incontinence?
Occurs due to bladder outflow obstruction meaning the bladder doesn’t empty properly when urinating and urine can leak out later as bladder too full.
Early and late presentation of overflow incontinence?
Early: complain of painful urinary retention
Late: Palpable bladder, chronic retention, wet and night and renal impairment. Mass is dull to percussion.
Causes of overflow incontinence?
More common in males (only type of incontinence more common in males) with benign prostatic hyperplasia
Other causes of outflow obstruction include bladder stones or tumours or other obstructions.
Describe treatment of overflow incontinence
test renal function (as if obstruction been long standing and severe could have damaged the kidneys), treat obstruction with catheter, rehabilitate bladder, teach intermittent self catheterisation (unlikely to ever be able to pass urine spontaneously again)
What type of urinary incontinence occurs due to bladder outflow obstruction?
Overflow incontinence
Define overactive bladder syndrome
Urgency that occurs with or without urgency incontinence and usually with frequency and nocturia
Patient presentation in urge incontinence?
Urinary frequency but only small voided volumes. Patients go to the bathroom frequently to avoid getting to the stage of uncontrollable passage of urine. There may be provocations to the urgency e.g. key in door, coughing, running water, laughing
Urge incontinence is a form of bladder dysfunction characterised by _________
detrusor muscle contraction during inhibition of voiding. These contractions increase in amplitude which increases urgency until get uncontrollable passage of urine.
How can different types of incontinence be diagnosed?
By urodynamics
Most common cause of urge incontinence? Who is this common in?
Idiopathic detrusor over-activity
In middle aged females
Causes of urge incontinence?
Most commonly idiopathic detrusor overactivity.
Other causes are cystitis due to infection or inflammation caused by stones or tumours
Excess central facilitation e.g. in stressful situations
Injury to spinal cord - high up injuries stops communication with the brain - low down injuries eliminate the whole reflex meaning nothing is controlling the bladder
Pelvic surgery or fractures can damage the parasympathetic nerves
Increased frequency in stressful situations e.g. in an exam is caused by what type of incontinence?
Urge incontinence
Detrusor muscle contraction during inhibition of voiding is a characteristic of what type of incontinence?
Urge incontinence
Treatment of urge incontinence?
Diet changes e.g. avoid caffeine
Bladder diary (sometimes understanding habits is enough for someone to change them)
Bladder retraining
Time bladder emptying
Pharmacotherapy includes antimuscarinics e.g. oxybutynin, tolterodine. Beta 3 adrenergic e.g. mirabegron. Botulinum toxin.
Neuromodulation if nothing else works with bladder pacemaker
Last line= surgery
Define Stress incontinence
Involuntary leakage on efforts or exertion or sneezing or coughing
Define enuresis?
Involuntary urination
What type of incontinence is being described?
Urine leaks due to increased intra abdominal pressure without a detrusor contraction?
Stress incontinence
In stress incontinence is their detrusor contraction?
No urine leaks due to increased intra abdominal pressure
What causes stress incontinence?
Due to damage of the pelvic floor or urethral function
most common in childbirth. Other causes are obesity, chronic coughing, diabetes, smoking, often a combination of many things
Presentation of stress incontinence?
Complain of wetness when coughing or sneezing. Will also have frequency as they want to avoid full bladder as would become more wet if coughed or sneezed
Treatment of stress incontinence?
Stop smoking, lose weight, pelvic floor exercises and physio
Pharmacotherapy doesn’t have a big role but duloxetine can be used to influence urethral tone.
Corrective surgery can be done.
