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Urinary Incontinence

Urinary Incontinence. Nachii Narasinghan. Types History and Examination Initial Assessment When to refer?. Types. Stress UI involuntary urine leakage on effort or exertion or on sneezing or coughing. Childbirth, age, chronic cough, obesity, prostate surgery Urge UI

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Urinary Incontinence

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  1. Urinary Incontinence NachiiNarasinghan

  2. Types • History and Examination • Initial Assessment • When to refer?

  3. Types • Stress UI • involuntary urine leakage on effort or exertion or on sneezing or coughing. • Childbirth, age, chronic cough, obesity, prostate surgery • Urge UI • involuntary urine leakage accompanied or immediately preceded by urgency • Diabetic neuropathy, MS, PD, Stroke, spinal cord injury, Alzheimer’s, UTI, spicy foods, caffeine, medication • Mixed UI • involuntary urine leakage associated with both urgency and exertion, effort, sneezing or coughing.

  4. History • Frequency of complaint • Volume passed/ incomplete emptying • Urgency/ dysuria/ frequency/ nocturia • Associated with cough/ sneeze/ laugh • Past Obx hx, PMH • QoL • Medication • Mobility and accessibility of toilets

  5. Medication • Diuretics • Anti histamines • Anxiolytics/ Hypnotics – BDZ/ Zopiclone • a-blockers – Doxazocin/ Tamsulosin • Anticholinergics – Ipratropium/ Tiotropium • TCAs – Amitriptyline/ Mirtazapine

  6. Examination • Abdo exam + DRE • Enlarged bladder, masses, loaded colon, faecal impaction, anal tone, prostate • Pelvic • Prolapse, neuro deficit, pelvic masses

  7. Initial assessment • Categorise UI – SUI/UUI/OAB/MUI • Identify factors that may require referral. • Bladder diary (min 3/7) • Urinalysis • Bloods – U&Es, FBC if renal impair/?DM • Measure post-void residual urine in women with Sx. of voiding dysfunction/ recurrent UTI.

  8. Who to refer? • Urgent referral • microscopic haematuria if aged 50 years and older • visible haematuria • recurrent or persisting UTI associated with haematuria if aged 40 years and older • suspected malignant mass arising from the urinary tract

  9. Further indications for referral • Refer women with: • symptomatic prolapse visible at or below the vaginal introitus • palpable bladder after voiding. • Consider referring if: • persisting bladder or urethral pain • clinically benign pelvic masses • associated faecal incontinence • suspected neurological disease

  10. symptoms of voiding difficulty • suspected urogenital fistulae • previous continence surgery • previous pelvic cancer surgery • previous pelvic radiation therapy.

  11. Thank you. now over to Rachel 

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