Professional Documents
Culture Documents
Urinary incontinence
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Classification of incontinence.
Stress incontinence
is an involuntary loss of urine that occurs during
increase intera abdominal pressure like during
coughing sneezing
Bet 15-30% of women over age of 65 have incont.
Mostly of stress type
30-50%of women with stress incont.have ergency
frequency and /or urge incont .so called mixed incont
Causes
. Classic or genuine stress incont. Is caused by
urethral hyper mobility or displacement of the urethra
and bladder neck from their normal anatomical
position
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Risk Factors
1. Gender ; women more than men in men usually
post prostatectomy and transit
2. Genetic
3. Race ,culture and enverment white > blacks
4. Overweight
5. Pregnancy and childbirth it most important due to
baby weight, relaxing hormon,viginal delivery
causing stretching of pelvic floor nerves,tear or
episitomy had 3 time increasing risk
6. Smoking :due to chronic cough
7. Age :weeking of muscle making elderly people
susceptible to stress incontinence
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Urinalysis
Post void urine volume
Micturition diary
Pad test
Urodynamic evaluation
History :
Assess characteristic,severty and impact on life
Assess risk factores and/or transit causes
Examination
oNeurological exam :like gait,lumbosacral nerve root
assess
oAbdomenal and flank for destintation
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Pad Test
A semi objective measurement of urine loss over a
given period of time
Weight gain sanitary towel of up to 8 gram is normal
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Treatment
Non surgical treatment
1. Alpha agonist
2. Oestrogen
3. Behaviour modification
4. Pelvic floor exercises
5. Biofeedback
6. Electrical stimulation
Surgical treatment
Urethral hypermobility then we do suspension of
the bladder neck and proximal urethra through
1. Reteropubic suspension (marshall-marchetti-
krantz and burch colposuspension
2. Transvaginal suspension
Intrinsic sphenictor defect
1. Pubovaginal sling (TVT,TOT)
2. Periurethral injections
3. Sphincter prostheses
Urge Incontinence
• Itis involuntary urine leakage accompanied by or
immediately preceded by sudden strong desire to
void
• The basic feature is detrusor instability and urine
loss while attempting to inhibit maturation
• There is overactive bladder with frequency
,ergency,and nocturia
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Neuropathic incontinence
Active found in patients who have spastic lesion
but in whom the sphincteric mechanism, still exerts
adequate closure pressure.
Active incontinence is most often associated with
suprasegmental or upper motor neuron lesion .
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Classfication
A –failure of reservoir function
• can be caused by poor compliance of the urinary
bladder.
Intravesical pressure raised with minimal bladder
filling exceeding the outlet resistance & causing
urinary leakage.
B –failure of retention function (arflxia)
• total loss of smooth & striated sphincteric activity
due to complete lesion of the sacral segment or cauda
equina.
• The external sphincter offer minimal resistance.
• The bladder musculature is atonic & lax
Diagnosis.
A complete urologic & neurologic evaluation should
be done to determine whether the condition arise
from detrusor or sphincteric dysfunction.
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Treatment.
conservative management
1- failure of reservoir function.
Anticholinergic drugs like oxybutynin
Tricyclic antidepresent like Imipramine
Antihistaminic drugs
2-Failure of retention mechanism.
Clean intermittent catheterization
Drug less effective like alpha agonist.
surgical management.
1- sphincterotomy. 4. diversion
2- Bladder augmentation. 5.Neurostimulation
3- Artificial sphincter.
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