Urinary Incontinence in women - PowerPoint PPT Presentation

1 / 13
About This Presentation
Title:

Urinary Incontinence in women

Description:

Urinary Incontinence in women Urinary incontinence Stress involuntary leakage of urine on effort, sneezing or coughing Urgency involuntary leakage accompanied ... – PowerPoint PPT presentation

Number of Views:204
Avg rating:3.0/5.0
Slides: 14
Provided by: Emily296
Category:

less

Transcript and Presenter's Notes

Title: Urinary Incontinence in women


1
Urinary Incontinence in women
2
Urinary incontinence
  • Stress involuntary leakage of urine on effort,
    sneezing or coughing
  • Urgency involuntary leakage accompanied or
    immediately preceded by a sudden desire to pass
    urine which is difficult to defer.
  • Mixed Combination of above

3
Other urinary problems
  • Overactive bladder urgency, frequency and
    nocturia
  • Chronic urinary retention ( overflow) bladder
    cant empty completely and becomes over distended
  • Detrusor over activity seen by urodynamic
    study's detrusor contractions during the
    filling phase (spontaneous or provoked)

4
SUI
  • Bladder pressure exceeds the urethral pressure
  • Associated with-
  • loss of pelvic floor or damage to urethral
    sphincter (pudendal nerve often damaged during
    NVD)
  • Increase in intra-abdominal pressure eg if
    pregnant or obese
  • Deficiency in supporting tissues prolapse
  • Lack of oestrogen may decrease urethral closure
    pressure

5
OAB
  • Multiple causes including
  • Lower urinary tract conditons eg UTI,
    obsturction, oestrogen deficiency
  • Neurological conditions brain stem, spinal cord
    or peripheral nerves
  • Systemic conditions eg HF or DM
  • Functional and behavioral disorder excess
    caffeine of constipation

6
Overflow
  • Outflow obstruction tumour, cystocele or
    constipation
  • Detrusor under activity causing distension often
    from neurological cause (spinal cord injury,
    pelvic fractures, DM, MS, surgery)

7
Other cause
  • Fistula
  • Urethral diverticula
  • Intercurrent illness
  • Congenital lesions
  • Cognitive impairment
  • Prolapse
  • Drugs alcohol, diuretics, alpha adrenergic
    blockers or agonists, diuretics etc

8
Risk factors
  • Increasing age
  • Vaginal delivery
  • Increase parity
  • High birth weight
  • Obesity
  • Family history

9
Consequences
  • Psychological problems depression, feelings of
    shame, loss of self confidence, poor self-rated
    health, low self esteem, guilt, social isolation.
  • Sexual problems incontinence during sex may
    cause embarrassment
  • Loss of sleep nocturia and fear of leakage.
  • Constipation due to limiting fluid intake.
  • Falls and fractures particularly in older people
    who have to rush to the toilet.
  • Impairment in quality of life.
  • Financial problems cost of pads, protective
    bedding, and laundry.

10
Differential
  • Vaginal discharge
  • Sweat
  • Amniotic fluid (if pregnant)
  • Psychological
  • Normal - The normal volume of urine passed per
    void is between 200 mL and 400 mL, average
    voiding frequency is 4-8 times daily, including
    one void per night.

11
Management
  • History and exam ( check for prolapse, dryness,
    vaginal tone)
  • Dipstick urine if positive M,CS.
  • Bladder diaries
  • Lifestyle advice
  • Pelvic floor excercises

12
SUI management
  • At least 12 weeks pelvic floor exercises
  • Surgery - Retropubic mid-urethral tape (open
    colposuspension and autologous rectal fascial
    sling are recommended alternatives)
  • Duloxetine 2nd line if not for surgery
  • Continence advisor

13
Urge Incontinence
  • Bladder training
  • Oxybutynin ( if not tolerated other
    anti-muscarinics eg tolteridine, solifenacin)
    review after 6 weeks and discuss s/e
  • Consider vaginal oestrogen
  • Desmopressin for nocturia (unlicensed)
  • If all fail consider referral for sacral nerve
    stimulation, botox or surgery
Write a Comment
User Comments (0)
About PowerShow.com