Urinary incontinence

37 Urinary incontinence





Questions



image What are the different types of incontinence?

image What are the treatment options for someone with genuine stress incontinence?

image What is the immediate treatment of acute urinary retention?

Incontinence is defined as the involuntary loss of urine and is a symptom, not a diagnosis.


The bladder wall is formed from the detrusor muscle, which is smooth muscle, and is compliant, stretching to allow urine to fill the bladder. There are several forms of incontinence (Fig. 3.37.1), although it may be multifactorial in the elderly:


image common causes
— stress

— urgency

— mixed (stress and urge)

— chronic retention/overflow

image rare
— fistulae

— ectopic ureter.

image

Fig. 3.37.1 Types of urinary incontinence.


Social embarrassment is often a major patient concern and patients feel ashamed to seek help.




Stress incontinence


Stress incontinence is the involuntary loss of urine when the pressure inside the bladder is greater than the urethral closing pressure. A sudden increase in intra-abdominal pressure (e.g. a cough or sneeze) raises the bladder pressure and causes a small amount of urine to be lost. It is common in middle-aged multiparous women and is caused by pelvic floor weakness, which is most commonly secondary to childbirth.



Investigations


Investigations include:


image examination: incontinence occurs when the patient coughs; there may be a cystocele
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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Urinary incontinence

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