urinary incontinence

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urinary incontinence and prolapse urinary incontinence compounding problems: embarrassment leads to silence time constraints lead to inadequate attention knowledge limits lead to patients accepting technology limits lead to inadequate investigation resource limits lead to inadequate access types of urinary incontinence: stress incontinence urge incontinence mixed overflow incontinence functional incontinence miscellaneous (uti, dementia) stress incontinence: loss of urine with increases in abdominal pressure caused by pelvic floor damage/weakness or weak sphincter(s) symptoms include loss of urine with cough, laugh, sneeze, running, lifting, walking urge incontinence: loss of urine due to an involuntary bladder spasm (contraction) complaints of urgency, frequency, inability to reach the toilet in time, up a lot at night to use the toilet multiple triggers mixed incontinence: combination of stress and urge incontinence common presentation of mixed symptoms urodynamics necessary to confirm chronic urinary retention: outlet obstruction or bladder underactivity may be related to previous surgery, aging, development of …

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pressure drug effects urogenital damage/dysfunction: vaginal delivery aging estrogen deficiency neurological disease psychological disease aging: gravity neurologic changes with aging loss of estrogen changes in connective tissue crosslinking and reduced elasticity pregnancy and childbirth: hormonal effects in pregnancy pressure of uterus and contents denervation (stretch or crush injury to pudendal nerve) connective tissue changes or injury (fascia) mechanical disruption of muscles and sphincters hormone effects: common embryonic origin of bladder urethra and vagina from urogenital sinus high concentration of estrogen receptors in tissues of pelvic support general collagen deficiency state in postmenopausal women due to the lack of estrogen (falconer et al., 1994) urethral coaptation affected by loss of estrogen increased intra-abdominal pressure: pulmonary disease constipation/straining lifting exercise ascites/hepatomegaly obesity drug effects: alpha-blocking agents terazosin prazosin phenoxybenzamine phenothiazines methyldopa benzodiazepines patient evaluation: history physical examination urinalysis pvr - if indicated symptoms of incomplete emptying longstanding diabetes mellitus history of urinary …

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cteriuria glucosuria proteinuria urine culture postvoid residual volume (pvr): if clinically indicated accurate pvr can be done by catheterization ultrasound pvr of 200 ml is considered inadequate use clinical judgement when interpreting pvr results in the intermediate range (50-199 ml) treatment: non-surgical fluid management reduce caffeine, alcohol, and smoking bladder retraining pelvic floor exercises pessaries continence devices treatment: non-surgical hormone replacement therapy medication to help strengthen the urethra medication to help relax the bladder non-surgical treatment: fluid management avoid caffeine and alcohol avoid drinking a lot of fluids in the evening non-surgical treatment: bladder retraining regular voiding by the clock gradual increase in time between voids double voiding non-surgical treatment: physiotherapy pelvic floor exercises (kegels) biofeedback electrical stimulation vaginal cones non-surgical treatment: pessaries support devices to correct the prolapse pessaries to hold up the bladder treatment : pessaries * we have seen that the % of new cap dx in …

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urinary incontinence and prolapse urinary incontinence compounding problems: embarrassment leads to silence time constraints lead to inadequate attention knowledge limits lead to patients accepting technology limits lead to inadequate investigation resource limits lead to inadequate access types of urinary incontinence: stress incontinence urge incontinence mixed overflow incontinence functional incontinence miscellaneous (uti, dementia) stress incontinence: loss of urine with increases in abdominal pressure caused by pelvic floor damage/weakness or weak sphincter(s) symptoms include loss of urine with cough, laugh, sneeze, running, lifting, walking urge incontinence: loss of urine due to an involuntary bladder spasm (contraction) complaints of urgency, frequency, inability to reach the to...

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