Urinary incontinence, nocturnal enuresis and urinary frequency Flashcards
(21 cards)
What is nocturnal enuresis?
Involuntary discharge of urine during sleep.
At what developmental age are children expected to be dry?
By age 5.
When is treatment usually considered for nocturnal enuresis?
At age 7 or older.
When is desmopressin used in children?
If alarm fails, is inappropriate, or short-term control is needed (e.g., travel).
What drug can be combined with desmopressin for overactive bladder symptoms?
Antimuscarinics like oxybutynin or tolterodine.
What is urinary incontinence?
Involuntary leakage of urine.
Name the four main types of urinary incontinence.
Stress, urgency, mixed, overflow.
What lifestyle advice should be given to women with UI?
Modify fluid intake, reduce caffeine, lose weight if BMI ≥30.
When are absorbent products recommended?
For severe mobility/cognitive impairment or as temporary management.
First-line treatment for urgency incontinence?
Bladder training for at least 6 weeks.
First-line treatment for stress incontinence?
Pelvic floor muscle training (8 contractions, 3×/day for 3 months).
What tests should be done before starting drug treatment for UI?
Urine dipstick and assessment of symptoms.
First-line drugs for urgency incontinence?
Immediate release oxybutynin, tolterodine, or darifenacin.
What drug is used if anticholinergics are unsuitable?
Mirabegron.
When should desmopressin be considered in women?
For troublesome nocturia.
What intravaginal treatment is used in postmenopausal women with atrophy?
Intravaginal oestrogen.
What is the role of duloxetine in stress incontinence?
Second-line option if pelvic floor training fails and surgery is not preferred.
What is pelvic organ prolapse?
Symptomatic descent of the vaginal wall or uterus.
What is the role of vaginal oestrogen in prolapse?
Used in women with prolapse and vaginal atrophy.
How does duloxetine work in stress urinary incontinence?
Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI).
It inhibits the reuptake of serotonin (5-HT) and norepinephrine (NE) which enhances stimulation of the pudendal nerve, which controls the external urethral sphincter.
As a result, there is increased sphincter muscle contraction during the storage phase of the bladder cycle.
This leads to improved bladder outlet resistance, reducing episodes of stress urinary incontinence.
How do antimuscarinics (also known as anticholinergics) work in urinary incontinence?
Antimuscarinics block muscarinic receptors—specifically the M3 receptors—on the detrusor muscle of the bladder.
During bladder filling, acetylcholine (ACh) is released and binds to M3 receptors, causing contraction of the detrusor muscle.
By blocking M3 receptors, antimuscarinics:
Reduce involuntary detrusor muscle contractions,
Increase bladder capacity,
Delay the urgency to urinate.
