FEMALE URINARY INCONTINENCE

Transcription

1 Nami Harvey Definitin FEMALE URINARY INCONTINENCE Urinary Incntinence (UI) is defined by the Internatinal Cntinence Sciety 1, the cmplaint f any invluntary leakage f urine. Prevalence is age dependent but it shuld always be cnsidered abnrmal regardless f age, mbility, mental status r frailty 2. Urinary Incntinence Classificatin Aetilgy Urdynamic Stress Incntinence(USI)= STRESS When there is an increase in intra-abdminal pressure the bladder pressure exceeds maximum urethral pressure, resulting in incntinence. It has been linked t pregnancy, prlnged labur, mde f delivery, besity and age. Incntinence may be precipitated by standing, cughing r exercise. This accunts fr almst 50% f female UI 3. Detrusr Overactivity = URGE A detrusr muscle cntractin is nrmally felt as urgency s this is invluntary urine lss due t uninhibited detrusr cntractins. They can either be spntaneusly r n prvcatin (e.g. a running bath). It is ften termed Overactive Bladder which dentes the symptms f urge, frequency, ncturia ± incntinence. It is mst cmmnly idipathic, but is cmmn in multiple sclersis and neurlgical disrders where it is termed neurgenic detrusr veractivity. This accunts fr 35% f female UI 3. Mixed Urinary Incntinence This accunts fr abut 10% f cases 3. Chrnic Retentin

2 Nami Harvey Urine leaks when bladder verdistensin causes verflw, either due t urethral bstructin (e.g. prstate in males) r detrusr inactivity (e.g. diabetes mellitus). It will result in a nn-painful bladder which remains palpable after a vid. This accunts fr 1% f urinary leakage 3. Bladder Anatmy and Physilgy 3,5 The bladder is an extra peritneal muscular rgan that lies behind the pubic It is pyramidal in shape with the superir surface cvered by peritneum, while the base, called the trigne, is brdered by ureters superirly, and the urethra (bladder neck) inferirly. The Internal Urethral Sphincter acts as the zne f maintenance f cntinence in females. symphysis in the pelvis. As the bladder fills with urine there is minimal change in pressure (intravesical) and the desire t urinate is suppressed by higher centres within the brain (abve the level f the Pns) until it is suitable t vid. Viding is cntrlled by the Pntine Micturitin Centre in the midbrain and this structure c-rdinates detrusr muscle cntractin and urethral relaxatin. Stimulatin f the parasympathetic chlinergic nerves (which leave the spinal crd at S2 S4) causes the detrusr muscle t cntract. Simultaneus relaxatin f the smth muscle f the urethra and the mid urethral The urethra striated is abut sphincter 4cm in allws length urine t pass frm the bladder until it is empty. with anterir supprt prvided by puburethral ligaments, and psterirly by pubcervical fascia. Clinical assessment

3 Nami Harvey Take a full histry, with emphasis n quantifying hw much f what type f liquid e.g. cffee/carbnated drinks cnsumptin, dysuria, haematuria and red flag symptms 4. It is essential t establish the effect UI has had n the patients quality f life 5. Investigatins 6 Urine dipstick Frequency/ Vlume chart-wmen shuld be encuraged t cmplete a fluid intake and utput diary ver 3-5 days Pst vid residual t exclude urinary retentin Urdynamics Imaging 'The study f the functin and dysfunctin f the urinary tract by any apprpriate methd' 1 Includes urflwmetry, cystmetry (static r ambulatry), urethral pressure prfiles and imaging techniques (videurdynamics) Ultrasund MRI Intraveus Pyelgram Treatment 7,8,9 1. General lifestyle measures Weight reductin if needed Fluid cnsumptin advice Crrectin f chrnic cugh The bladder wall is made f smth detrusr muscle that is under vluntary cntrl. The first sensatin t vid is at apprximately 150mls and the bladder capacity is apprximately 500mls.

4 Nami Harvey Adjust medicatin 2. Pelvic flr Physitherapy Fr at least 3 mnths Electrical stimulatin and / r Bifeedback may be ffered in thse wh cannt cntract pelvic flr. 3. Teach self catheterisatin 4. Bladder training Bladder drill designed t teach patients t regain bladder cntrl by imprved crtical inhibitin ver detrusr cntractins 5. Pharmaclgical treatment Antichlinergic agents Vaginal estrgen may have sme benefit in the pstmenpausal wman Btulinum Txin 6. Surgical measures Tensin Free Vaginal tape (TVT)-prcedure f chice as is less invasive and has quicker pstperative recvery Burch Clpsuspensin (may be a primary prcedure but nw ften used as backup fr failed TVT) Periurethral injectins ( e.g. silicne, hyalurnic acid, cllagen) References 1. Internatinal Cntinence Sciety. 3 rd Internatinal Cnsultatin n Incntinence. Plymuth: Health Publicatins Ltd; Internatinal Cntinence Sciety, NICE. Urinary Incntinence: the Management f Urinary Incntinence in Wmen. Lndn: Natinal Cllabrating Centre fr Wmen's and Children's Health, Ryal Cllege f Obstetricians and Gyneclgists, Impey L. Obstetrics & gynaeclgy. Chichester: Wiley-Blackwell; 2012

5 Nami Harvey 4. Kirby M, Artibani W, Cardz L et al. Overactive bladder: the imprtance f new guidance. Int J Clin Pract 2006; 60: Cruickshank M. Obstetrics and gynaeclgy clinical cases uncvered. Oxfrd: Wiley-Blackwell; Eurpean Assciatin f Urlgy. Guidelines n Urinary Incntinence. Eurpean Assciatin f Urlgy, Available at inence.pdf (accessed 15/02/13). 7. Flttrp S, Oxman AD. Identifying barriers and tailring interventins t imprve the management f urinary tract infectins and sre thrat: a pragmatic study using qualitative methds. BMC Health Serv Res 2003; 3: Thaka R, Stantn, S. Regular review: management f urinary incntinence in wmen. BMJ 2000;321; Lee RS, DeAntni E, Daneshgari F. Cmpliance with recmmendatins f the urdynamic sciety fr standards f efficacy fr evaluatin f treatment utcmes in urinary incntinence. Neururl Urdyn 2002; 21: