What is urinary incontinence?
The involuntary leakage of urine.
The concept of social continence (ie. to void in a socially acceptable place at a socially acceptable time) highlights the impact of cognitive, physical and environmental aspects.
Give some changes that occur with ageing that may affect voiding.
- increased collagen deposition in urethral and bladder walls result in decreased urethral closing pressure
- prostatic volume increases with age, affecting the voiding stage of mictruition
- reduced production of ADH, leading to reduced renal concentrating ability
- atrophic vaginitis in postmenopausal women
List the bladder storage symptoms.
- daytime frequency
- nocturia
- urgency
What is overactive bladder syndrome (OAB)?
A group of symptoms:
- daytime frequency
- nocturia
- urgency
with or without incontinence, in the absence of UTI or other pathology.
List the bladder voiding symptoms.
- hesitancy
- slow stream
- straining to void
- feeling of incomplete emptying
- need to immediately re-void
- post-mictruition leakage
- postural dependent mictruition
- dysuria
- urinary retention
What is stress urinary incontinence?
The involuntary loss of urine on physical examination, sneezing or coughing.
What is urgency urinary incontinence?
The involuntary loss of urine associated with urgency.
What is postural urinary incontinence?
The involuntary loss of urine associated with change of body position.
What is nocturnal enuresis?
The involuntary loss of urine occurring during sleep.
What is mixed urinary incontinence?
The involuntary loss of urine associated with urgency and also physical examination, sneezing, or coughing.
What is continuous urinary incontinence?
The continuous involuntary loss of urine.
What is insensible urinary incontinece?
Urinary incontinence where the patient is unaware of how it occurred.
What is functional urinary incontinence?
Urinary incontinence due to decreased motivation, initiative, or ability to get to the toilet when the need arises.
A patient presents complaining of urinary incontinence. What features of history should be explored?
Detailed social history, including access to toileting facilities, ability to attend to lower body hygiene, need for carers and aid toileting.
Obstetric history in women, including parity, instrumental delivery, and birth complications.
Surgical history (abdominal or pelvic) in men or women.
Detailed bowel history, including effect of constipation on LUTS, and presence of coexisting faecal incontinence.
Record of pad usage if using.
Impact on carer and assessment of carer burden should be sought.
Drug history.
What are the steps of a complete continence examination?
- review of bladder and bowel diary
- abdominal examination
- urine dipstick and MSU
- PR examination (including prostate examination in male)
- external genitalia review (atrophic vaginitis in females)
- post-micturition bladder scan
What is a bladder diary?
A useful tool to obtain reliable information on timings on voids and incontinence episodes.
A bladder diary is completed for three consecutive days and records volumes of fluid and food intake, as well as voided volume.
When examining the external genitalia as part of a continence examination, what should you look for?
- Candida infection
- contact dermatitis
- vaginal atrophy
- prolapse
What examining the abdomen as part of a continence examination, what should you look for?
- previous surgical scars
- palpable masses
- faecal impaction
What is the indication of PR examination as part of a continence examination?
- check anal tone
- check presence of hard stool in the rectum
- prostate examination in men
What is the indication of per vaginal examination as part of a continence examination?
- vaginal atrophy
- asking patient to cough to demonstrate any prolapse and stress incontinence
What is the purpose of performing a post-micturition bladder scan?
Post-void residual volume increases in the presence of:
- severe constipation with faecal impaction
- medications with anticholinergic effects
How can stress urinary incontinence be treated?
- pelvic floor exercises
- fluid intake
- caffeine reduction
- surgical intervention after MDT
- treat constipation
How can OAB be treated?
- pelvic floor exercises
- caffeine reduction
- bladder retraining
- oxybutynin
- Botulinum toxin
What is the conservative management of urinary incontinence?
- reduction in caffeine intake
- adequate hydration
- bladder training
- pelvic floor exercises
