Tutorial 15: Urinary Incontinence Flashcards

Question

What is nocturia?

Answer 1

Waking up at night to go. Usually associated with **excessive fluid intake** or a **general medical condition**

Answer 2

* **Cortical** lesions – loss of social awareness, sensation, etc. * **Spinal** lesions – alteration of sympathetic/parasympathetic tone * **Metastatic** carcinomas – cause back pain as primary symptom * **Cauda equina syndrome**

Answer 3

* **Anticholinergics** – urinary retention --\> overflow incontinence α-agonists – urinary retention * **α-antagonists** – urethral relaxation * **Diuretics** – overwhelming bladder capacity * **Ca-blockers** – decreased smooth muscle contractility --\> urinary retention * **Sedatives** – immobility --\> functional incontinence * **ACEi & ARBs** – diuretic effect, as well as pelvic floor relaxation + cough – exacerbation of stress incontinence * **Dopaminergics** – urinary urgency & constipation Antihistamines

Answer 4

* Age * Female gender * Multiparity * European background * Overweight * Smoking * Inactivity * Depression * Diabetes * Incontinence/enuresis as a child * Recurrent UTI - pelvic inflammation * Neurological disorders * Pelvic surgery * Constipation

Answer 5

1. Presenting complaint: What is the problem? Why is it a problem? 2. Incontinence * Duration * Severity – pads, brand of pads, how often change is needed, nocturnal symptoms Precipitating factors * Affect on quality of life 3. Fluid-intake 4. Associated symptoms * Storage – frequency / nocturia * Voiding – urinary flow; incomplete emptying? UTI * Bladder pain * Genital prolapse * Bowel symptoms 5. QoL: Physical, Emotional, Social, Role performance, Symptoms 6. Obstetric history * Birth weight, Parity, Mode of delivery, Problems * PMHx * Medical problems: esp. asthma / cough / DM / neuro * Past surgery esp. bladder / vaginal * Radiotherapy * Medications: anticholinergics; alpha-blockers; diuretics Smoking 1. Gynae history: bleeding; smears 2. Environmental factors * Distance to toilet * Access to toilet * Need for assistance and response time * Clothing, access, dexerity * Mobility in chairs * Bed * Toilet identification

Answer 6

1. **CNS**: Rule out spinal cord compression Affect, motivation, dementia 2. **Abdomen**: Mass? Ovary, uterus, bladder, bowel mass, stool 3. **Pelvic** * External female genitalia oestrogenisation * Prolapse * Tenderness * D/C 4. **Pelvic floor assessment:** flick contractions; long contractions 5. **PR**: Stool, pelvic mass, prostate size, symmetry, consistency

Answer 7

1. **Bloods** 2. **MSU/Urinalysis**: Rule out UTI 3. **Post-void residual urine** * – Bladder scanner * – “In-out” catheter 4. **Bladder diary** * – mL @ each void: maximum and minimum * – Fluids taken: type and volume * – Pads used * – Incontinence episodes 5. **Cystoscopy and bladder stretch biopsy**: Exclude interstitial cystitis if refractory to medical therapy 1. The most important differential diagnoses of incontinence to rule out are neurological conditions that may also cause incontinence as part of their clinical syndromes e.g. multiple sclerosis, cord lesions/infection, etc. The other main differential in women is urinary tract infection; in males, prostatitis may also cause incontinence. 6. **Urodynamic studies** 1. Looking at the _pressure of the bowel_ as a _proxy for the peritoneal cavity_ compared to the pressure of the bladder 2. Also looking at _residual volume, sphincter pressure, urethral pressures_, etc.

Answer 8

1. **Pads** 2. **Catheterisation** 3. Medication: mainly drugs that cause urinary retention such as **α-agonists, anticholinergics, tricyclics**, etc. 4. **Pelvic floor exercises**: Repeated contraction of the levator ani muscles. Should be coached on this rather than given pamphlets – many just do valsalva or gluteal contraction instead of pelvic floor activation. * **6-12wks** at least for signs of improvement, and must be **performed long-term** for maintenance of results. * Better on younger women (who can more accurately and identify the correct muscles to activate) * Can also be done **electrically** with probes 5. **Weight loss** (modification of risk factors) – the more weight people lose, the better their symptoms. This also applies to modification of other risk factors e.g. smoking, depression 6. Behavioural changes 1. **Timed voiding** (e.g. on 2-hour schedule) 2. **Fluid restriction** 3. **Diet** – spicy foods tend to worsen urge incontinence. Other food groups to avoid include chocolate and citrus fruits. 7. **Surgery** - TVT

Answer 9

Stress 1. Pelvic muscle exercises 2. Tension free vaginal tape 3. Surgical bladder neck suspension Urge 1. Bladder retraining 2. Antimuscarinic agents Overflow 1. Treat BPH 2. Catheterisation: Intermittent or Indwelling Functional 1. Behavioural interventions 2. Incontinence undergarments and pads

Answer 10

Pelvic organ prolapse is the herniation of various intra-abdominal structures into the pelvis. A variety of factors cause **damage to the endopelvic fascia and muscles of the pelvic floor,** allowing structures to push through with appropriate pressure. These factors include: * childbirth * surgery * menopause * tumours * neuropathies (particularly diabetic neuropathy) * and chronic conditions that increase intra-abdominal pressure (e.g. obesity, COPD, constipation, etc.) * reduce connective tissue strength (e.g. connective tissue diseases).

Answer 11

* childbirth * surgery * menopause * tumours * neuropathies (particularly diabetic neuropathy) * chronic conditions that increase intra-abdominal pressure (e.g. obesity, COPD, constipation, etc.) * reduce connective tissue strength (e.g. connective tissue diseases).

Answer 12

1. Pelvic Floor exercises 2. Pessaries 3. Repair

Tutorial 15: Urinary Incontinence Flashcards

(36 cards)