Urinary Incontinence
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Urinary Incontinence






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Urinary Incontinence Urinary Incontinence Presentation Transcript

  • Urinary Incontinence
    • Involuntary loss of urine that is objectively demonstrable and is a social or hygienic problem.
    • Affects physical, psychological, social well being -> Reduce quality of life
    • Prevalence, ↑ with age
    • Common in institutionalized women, those in residential nursing homes
  • Some definitions…
    • Stress incontinence is loss of urine on physical effort
    • Urge Incontinence is an involuntary loss of urine associated with a strong desire to void.
    • Overflow Incontinence occurs without any detrusor effort when the bladder is over-distended.
    • Urgency is a sudden desire to void
    • Frequency is passing of urine seven or more/day or being awoken from sleep more than once a night to void.
  • Classification of Incontinence
    • Urethral Sphincter Incompetence (Urodynamic stress Incontinence)
    • Detrusor overactivity/Unstable bladder (Nueropathic or non-nueropathic)
    • Retention with overflow
    • Congenital causes
    • Miscellaneous
    • Congenital causes
    • Fistula
  • 1a : Urodynamic Stress Incontinence
    • Involuntary leakage of urine during increased abdominal pressure in the absence of detrusor contraction.
    • Symptoms: STRESS INCONTINENCE, urgency, frequency, urge incontinence, prolapse ±
    • Examination: Stress incontinence when cough, look for prolapse, cystourethroceles
      • Also asses her vaginal capacity and her ability to elevate bladder neck.
    • Urodynamic studies will define cause of incontinence
    • Causes of USI
      • Damage to nerve supply of pelvic floor and urethral sphincter caused by childbirth (Prolonged second stage, large babies, instrumental deliveries)
      • Menopause +tissue atrophy, damage to pelvic floor, ineffective compression during stress, incontince
      • Congenital cause (nulliparous women) – Connective tissue disorder esp collagen
      • Chronic causes, Obesity, COPD, Raised Interabdominal pressure and constipation
  • 1b: Detrusor Over-activity
    • Involuntary detrusor contraction during the filing phase which may be spontaneous or provoked.
    • Symptoms: Urgency, urge incontinence, frequency, nocturia, stress incontinence, enuresis, voiding difficulties
    • Examination: Any mass that may compress bladder, prolapse TRO
    • Causes: Idiopathic, Poor toilet habit training, psychological, Nueropathy, Incontinence surgery, outflow obstruction, smoking aw
  • 1c: Retention with overflow
    • Insidious failure of bladder empting may lead to chronic retention and finally, when normal voiding is ineffective, to overflow incontinence
    • Caused by: LMN/UMN lesions, urethral obstructions, pharmacological
    • Symptoms: poor stream, incomplete bladder emptying, straining to void, overflow stress incontinence
    • Investigations: Cystometry (dx), bladder US, IV Urography to investigate state of upper urinary track and TRO reflux
  • 1d: Congenital
    • Epispadias: Faulty midline fusion of mesoderm causing wide bladder neck, short urethra, symphysial separation, imperfect sphincter control causing stress incontinence
    • Rx with urethral reconstruction or artificial urinary sphincter
  • 2A: Congenital
    • Bladder Exstrophy: Absence of anterior andominal wall and anterior bladder wall. Rx extensive reconstructive surgery in neonatal period
    • Single/Bilateral Ectopic ureter with ectopic opening outside bladder (eg vagina, perineum). Rx exicion of ectopic ureter and and upper pole of kidney that it drains
    • Abnormal opening between the urinary track and outside.
    • Obstetric cause : Obstructive labour with compression of bladder between presenting head and bony pelvis
    • Gynecological cause : AW pelvic surgery, radiotherapy, pelvic malignancy
    • Treated by primary closure or surgery
    • Urine C&S- tro Infections
    • Pad test
    • Measure Postvoidal Residual Volume by bladder ultrasound or urethral catheter >100mL in more than one occasion->+
    • Cough Stress Test. 250mL into bladder
    • Abdominal leak point pressure
    • Urodynamic studies
      • Uroflowmetry. Bladder outlet obstruction
      • Cystometry. Detrusor activity, differentiate involuntary detrusor contraction or increase intraabdominal pressure
    • Cystogram
      • Stress incontinence, Cystocele, Sphincter activity, fistula
    • Cystoscopy
      • Tumors, stones
  • Treatment
      • Palliative – Fluid restriction, Protective perineal pads, Bladder retraining, Pelvic Floor exercise (Kegel)
      • Devices – Weighted vaginal cones, Vaginal pessaries, contraceptive diaphragms
      • Surgery – to restore the proximal urethra and bladder neck to zone of intraabdominal pressure transmission and to increase urethral resistance
      • Colposuspension Operation, Artificial Sphincter