Dr. Nedaa Bahkali 2012 Slide 2 Urinary incontinence is defined
as involuntary leakage of urine. Slide 3 Stress urinary
incontinence (SUI): involuntary urine leakage on exertion or with
sneezing or coughing. Urge urinary incontinence: women have
difficulty postponing urination urges and generally must promptly
empty their bladder on cue and without delay. If urge urinary
incontinence is objectively demonstrated by cystometric evaluation,
the condition is known as detrusor overactivity (DO). Slide 4 Mixed
urinary incontinence : When both stress and urge components are
present, it is called. Slide 5 Prevalence of 25 - 55 %. Among women
with urinary incontinence, the most common condition is stress
incontinence, which represents 29 to 75 %of cases. Detrusor
overactivity accounts for up to 33 % of incontinence cases. whereas
the remainder is attributable to mixed forms. Slide 6 Slide 7
Detrusor muscle External and Internal sphincter Normal capacity
500-600cc First urge to void 150cc Slide 8 Slide 9 Slide 10 Storage
Reflex Slide 11 Micturition Reflex Slide 12 o Age o Pregnancy o
Childbirth o Menopause o Hysterectomy o Obesity o Chronically
increased abdominal pressure Chronic cough Constipation
Occupational risk o Smoking Slide 13 Pressure Transmission Urethral
Support Slide 14 In an ideally supported urogenital tract,
increases in intra-abdominal pressure are equally transmitted to
the bladder, bladder base, and urethra. In women who are continent,
increases in downward-directed pressure from cough, laugh, sneeze,
and Valsalva maneuver are countered by supportive tissue tone
provided by the levator ani muscle and vaginal connective tissue.
Slide 15 In those with a weakened supportive "backboard", however,
downward forces are not countered. This leads to funneling of the
urethrovesical junction, a patent urethra, and in turn, urine
leakage. Slide 16 Slide 17 Urethral support is integral to
continenc (1) ligaments along the lateral aspects of the urethra,
termed the pubourethral ligaments; (2) the vagina and its lateral
fascial condensation; (3) the arcus tendinous fascia pelvic; (4)
levator ani muscles. With loss of urethral support, the urethra's
ability to close against a firm supportive backboard is diminished.
Slide 18 Slide 19 Slide 20 Slide 21 History : Duration, severity,
symptoms, previous treatment,(Urinary Frequency, Urinary Retention,
volume of urine lost, Postvoid dribbling is classically associated
with urethral diverticulum) medications, Past medical hx, GU
surgery, Ob hx Voiding Diary Slide 22 Urge Incontinence Stress
Incontinence Symptom No Yes Urgency No Yes Frequency with urgency
Yes No Urine leakage with increased intra-abdominal pressures
smallLarge Amount of urinary leakage with each incontinence episode
YesOften No Ability to reach the toilet in time following an urge
to void Seldom Usually Waking to void at night Slide 23 Diuretics
Anticholinergics - antihistamines, antipsychotics, antidepressants
Seditives/hypnotics Alcohol Narcotics -adrenergic
agonists/antagnists Calcium channel blockers Slide 24 General
Inspection and Neurologic Evaluation evidence of atrophy.
neurologic evaluation of the perineum: bulbocavernosus reflex
normal circumferential anal sphincter contraction, colloquially
called an "anal wink", Slide 25 Pelvic Organ Prolapse Evaluation
Slide 26 Q-Tip Test Slide 27 Urinalysis and Culture Postvoid
Residual Cystometrics Uroflowmetry Slide 28 Slide 29
Conservative/Nonsurgical: Pelvic Floor Strengthening Exercises
Pelvic Floor Muscle Training (PFMT) Slide 30 Electrical Stimulation
Biofeedback Therapy Dietary Scheduled Voiding Estrogen Replacement
Slide 31 Slide 32 Medications: Pharmaceutical treatment plays a
minor role in the treatment of women with SUI. imipramine is
reasonable to aid urethral contraction and closure. Recently,
duloxetine a selective serotonin and norepinephrine reuptake
inhibitor, has been evaluated for the treatment of SUI Slide 33
Slide 34 Periurethral Bulking Agents Slide 35 Retropubic
Urethropexy Pubovaginal Slings Midurethral Slings Slide 36 Slide 37
Antimuscarinics: tertiary amines that act to block the muscarinic
receptors in response to acetocholine First line Oxybutinin
(Ditropan) Tolteridine (Detrol) Slide 38
