Urinary Incontinence Nachii Narasinghan

Types History and Examination Initial Assessment When to refer?

Types Stress UI ◦ involuntary urine leakage on effort or exertion or on sneezing or coughing. ◦ Childbirth, age, chronic cough, obesity, prostate surgery Urge UI ◦ involuntary urine leakage accompanied or immediately preceded by urgency ◦ Diabetic neuropathy, MS, PD, Stroke, spinal cord injury, Alzheimer’s, UTI, spicy foods, caffeine, medication Mixed UI ◦ involuntary urine leakage associated with both urgency and exertion, effort, sneezing or coughing.

History Frequency of complaint Volume passed/ incomplete emptying Urgency/ dysuria/ frequency/ nocturia Associated with cough/ sneeze/ laugh Past Obx hx, PMH QoL Medication Mobility and accessibility of toilets

Medication Diuretics Anti histamines Anxiolytics/ Hypnotics – BDZ/ Zopiclone a-blockers – Doxazocin/ Tamsulosin Anticholinergics – Ipratropium/ Tiotropium TCAs – Amitriptyline/ Mirtazapine

Examination Abdo exam + DRE  Enlarged bladder, masses, loaded colon, faecal impaction, anal tone, prostate Pelvic ◦ Prolapse, neuro deficit, pelvic masses

Initial assessment Categorise UI – SUI/UUI/OAB/MUI Identify factors that may require referral. Bladder diary (min 3/7) Urinalysis Bloods – U&Es, FBC if renal impair/?DM Measure post-void residual urine in women with Sx. of voiding dysfunction/ recurrent UTI.

Who to refer? Urgent referral ◦ microscopic haematuria if aged 50 years and older ◦ visible haematuria ◦ recurrent or persisting UTI associated with haematuria if aged 40 years and older ◦ suspected malignant mass arising from the urinary tract

Further indications for referral Refer women with: ◦ symptomatic prolapse visible at or below the vaginal introitus ◦ palpable bladder after voiding. Consider referring if: ◦ persisting bladder or urethral pain ◦ clinically benign pelvic masses ◦ associated faecal incontinence ◦ suspected neurological disease

◦ symptoms of voiding difficulty ◦ suspected urogenital fistulae ◦ previous continence surgery ◦ previous pelvic cancer surgery ◦ previous pelvic radiation therapy.

Thank you. now over to Rachel 