Urinary Incontinence

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

285

Pages:

5
Author:

Mariam A. A.

Urinary Incontinence History I am sorry you are going through this Tell me more about it? When did this start? How often does it happen? Does it always happen whenever you need to go to the toilet? Have you had anything like this before? Can you think of what might have caused it? Does anything trigger it? e.g. coughing? Does anything make it better or worse? Impact on life? Urinary symptoms: Do you feel like you need to run and cannot make it? How much urine comes out? What colour is it? Is it cloudy? Is it painful? Does it have blood? Do you urinate at night? Do you need pads? Can you control it? Associated features Changes to bowel habits Abnormal bleeding Abnormal discharge Fever Any abdominal, pelvic or flank pain? Are there any lumps? Any changes to sensations? Menstrual history Menarche DDx UTI STI Pelvic floor muscle weakness Stress induced e.g. coughing Neurological dysfunction e.g. diabetic nephropathy Urge incontinence e.g. detrusor muscle over activity and loss of voluntary control -> MS, Parkison disease, SC injury, brain tumor or trauma, UTI, constipation, diuretics high caffeine intake Pelvic organs prolapse Pregnancy Trauma Lots of water and caffeine drinking Investigations Vitals FBE -> anaemia, reducing immunity, uric acid, EUC (renal infection can affect renal function so we want to assess for electrolyte derangement) BSL -> for diabetic nephropathy Urine -> infections, proteins, bleeding, protein: creatinine High and low vaginal swaps and STI screen Pelvic exam and bimanual exam TVUS and pelvic ultrasound Speculum exam Renal scan Urodynamic studies -> assess bladder and urethra function Bladder diary Post-void residual volume (PVR) measurement (via ultrasound or catheterization) is missing, is critical for assessing overflow incontinence or incomplete bladder emptying. Management Depends on cause If neurological dysfunction due to diabetes -> diabetes management If UTI -> antibiotics If STI -> antibiotics If urge incontinence -> anticholinergic medications, botox injections If pelvic organ prolapse -> pessaries, pelvic muscle training, surgical management If pelvic floor muscles -> exercise and lifestyle change