Urinary incontinence (URO) Flashcards
(34 cards)
What is urinary incontinence?
Common condition characterised by uncontrollable leakage of urine
Which group of people is urinary incontinence most common in?
Elderly females
What are the types of causes of urinary incontinence? (3)
- neurological causes
- genitourinary causes
- reversible causes
What are the neurological causes of urinary incontinence? (2)
- multiple sclerosis
- spinal injury
What are the genitourinary causes of urinary incontinence? (4)
- trauma to pelvic floor
- pelvic floor weakness
- sphincter deficiency
- bladder outlet obstruction
What are the reversible causes of urinary incontinence? (2)
- diuretics
- UTIs
What are the types of urinary incontinence? (4)
- stress incontinence
- urge incontinence
- mixed incontinence (stress + urge)
- overflow incontinence
What is stress incontinence?
- pelvic floor laxity –> urethra loses support –> increase in intra-abdominal pressure overwhelms sphincter muscles
- urination associated with sneezing, coughing, laughing, pregnancy
What is urge incontinence?
- over-active bladder –> involuntary urination preceded by feeling of not having to go
- overactivity of detrusor muscle –> strong sudden sense of urgency followed by involuntary leakage
- associated with nocturia and polyuria, and can be due to UTI, stroke, Parkinson’s, MS
What is mixed incontinence?
Combination of stress and urge incontinence
What is overflow incontinence?
Caused by urinary retention due to bladder outlet obstruction or ineffective detrusor muscle –> bladder pressure increases to exceed urethral resistance –> leakage
What is a symptom of overflow incontinence?
Weak/intermittent urinary stream or hesitancy
Frequent loss of small amounts of urine
What are some causes of overflow incontinence? (3)
- drug causes of urinary retention - TCA (amitriptyline) due to cholinergic effect, opioids
- blockage due to - BPH, prostate cancer, urethral strictures, severe constipation, prolapsed uterus
- ineffective detrusor - due to disorders affecting autonomic innervation of bladder e.g. DM, SC injury, CES, anticholinergics
What are some signs of urinary retention (overflow incontinence)? (3)
- palpable bladder
- suprapubic tenderness
- delirium in elderly patients
What might you find on examination in urinary incontinence? (3)
- vaginal bulge/pressure
- urogenital atrophy
- abnormal bulbocavernous and anal wink reflexes –> suggests disruption of sacral reflex
What are some risk factors for stress incontinence? (3)
- vaginal childbirth
- pregnancy
- hysterectomy
What are some risk factors for urge incontinence? (5)
- advancing age
- high BMI
- smoking
- caffeine
- UTI, stroke, Parkinson’s, MS
What are the first-line investigations for urinary incontinence? (5)
- cough stress test - urine leakage
- urinalysis - rule out UTI
- post-void residual measurement
- empty supine stress test
- urodynamic studies - differentiate types of incontinence
What does post-void residual measurement show in urinary incontinence?
- after a spontaneous void
- may confirm urinary retention if overflow incontinence suspected
- determined with US or sterile catheterisation
- elevated if >100mL or >50% voided volume
What does empty supine stress test show in urinary incontinence?
Valsalva manoeuvre in dorsal lithotomy position after spontaneously voiding –> urine leakage if positive
Why are bladder diaries completed in urinary incontinence?
To assess frequency and volume of micturition, completed for a minimum of 3 days
What examination excludes pelvic organ prolapse in urinary incontinence?
Vaginal exam - also assesses ability to initiate voluntary contraction of pelvic floor muscles
Why is urine dipstick and culture done for urinary incontinence?
To exclude UTI - can cause urgency, frequency and/or incontinence
What investigation is requested for suspected bladder outflow obstruction (–> overflow incontinence), and what does it show?
Urodynamic studies showing:
- increased detrusor pressure
- reduced urine flow rate
