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

2. 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 :1

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

4. 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

5. Pelvic Floor Muscles

6. Normal bladder function6

7. Birth Trauma

8. Birth Trauma

9. 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

10. 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

11. 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

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

13. 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.

14. Thank You