Evaluation of female patient with Urinary incontinence Dr. Shagufta Tahir Associate Professor Obstetrics & Gynaecology Liaquat National Medical College & Hospital

What is Urinary Incontinence? Urinary Incontinence (UI) is the involuntary loss of urine. Six out of every seven cases of adult incontinence occurs in women. This is due to biologic gender differences: 1. The urethras in women are shorter than in men 2. Women bear children Between 10% and 30% of women experience incontinence during their lifetimes * American Urological Association, Female Stress Urinary Incontinence Guidelines Panel. The Surgical Management of Female Stress Urinary Incontinence. 1997:1

What is pelvic floor Dysfunction? Urinary incontinence. Fecal incontinence. Pelvic Organ prolapse. Sexual Dysfunction.

4. Identify the pelvic diaphragm and its components Sphincter Vaginae (or Levator Prostatae) Pubic Symphysis Levator Prostatae or Sphincter Vaginae Urethra Pubic Symphysis Vagina Puborectalis Rectum Pubococcygeus Puborectalis Perineal Body Pubococcygeus Obturator Internus Coccyx Iliococcygeus Coccygeus Iliococcygeus Coccyx Coccygeus Sacrum Superior View Inferior View

Pelvic Floor Muscles

Normal bladder function 6

Birth Trauma

Birth Trauma

What are Some Common Causes of Female Urinary Incontinence? Pelvic surgery Injuries to the pelvic region or to the spinal cord Neurological diseases Multiple sclerosis Obesity Urinary tract infection Degenerative changes associated with aging Childbirth Post-menopausal

Types of Urinary Incontinence Urinary incontinence is generally divided into following groups according to the malfunction involved: Stress Urge Overflow Fistula Congenital Often, more than one type of incontinence is present. Approximately 40% of all incontinence cases fall into more than one category

A good history and examination Gives you significant information which will differentiate between major types of incontinences. Voiding diary for few days Pads weighing 13

Behavioral Treatments Bladder training Pelvic muscle exercises (PMEs) Vaginal weight training Pelvic floor electrical stimulation Incontinence pads

Treatment pathway Lifestyle interventions Refer Mixed UI OAB with or without urge UI Stress UI Urodynamics if appropriate, not routinely for pure stress UI Assess and categorise Assessment Conservative management Surgical management This algorithm offers a summary of the treatment pathway for UI that includes initial assessment, conservative and surgical management and should be interpreted with reference to the NICE guideline ‘Urinary incontinence: the management of urinary incontinence in women’ and the quick reference guide.

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