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URINARY INCONTINENCE (TREATMENT (LIFESTYLE INTERVENTIONS (normalise fluid…
URINARY INCONTINENCE
TREATMENT
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treatment should start with conservative treatment and this usually includes 2 distinct approaches: lifestyle interventions, bladder retraining
LIFESTYLE INTERVENTIONS
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cut down alcohol and restrict caffeine - these drinks should constitute no more than 1/3 of the total daily fluid intake
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DRUG THERAPY
TREAT OAB
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SE: dry mouth, dizziness, nausea, constipation
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antimuscarinics: SOLIFENACIN, FESOTERODINE, OXYBUTININ, DARIFENACIN, TOLTERODINE, TROSPIUM,PROPIVERINE
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CLINICAL PRESENTATION
urinary incontinence usually presents as part of a symptom complex comprising stress incontinence, frequency, urgency, nocturia
ENQUIRE ABOUT VOIDING: hesitancy, poor stream, intermittent stream, straining to void, feeling of incomplete emptying and post-micturition dribbling
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nocturia in elderly also carries the risk of falls, with fractured neck of femur the common outcome
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DIAGNOSTIC EVALUATION
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brief neuro assessment of S2,3,4 dermatomes - if symptoms of anal incontinence are present = anal sphincter tone should be determined by digital examination
FURTHER ASSESSMENT
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URINALYSIS - leucocytes and nitrites = UTI - mid stream sample if not responding to abx. haematuria prompts cystoscopy and US of upper renal tracts. glycosuria may suggest DM - can predispose you to recurrent UTI and urinary frequency
CYTOSCOPY - required only for the assessment of haematuria or recurrent UTI - not required for those suffering purely from an overactive bladder
US OF POST VOID RESIDUAL - performed in the presence of symptoms of voiding difficulty or in an elderly pt with incontinence
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AETIOLOGY
SUI
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series of predisposing factors which often explain the condition: PREG/PROLAPSE/MENOPAUSE/COLLAGEN DISORDER/OBESITY
MENOPAUSE
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There is evidence that the withdrawal of oestrogen reduces be so called Maximal urethral closure pressure.
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OAB
Neurological conditions typically Multiple Sclerosis stroke or cervical spine lesions and cause overactivity but it is very uncommon for such patients to present Denovo @ an urogynaecology clinic
Where is the link between the psychological upset and overactive bladder with such patients having higher background of anxiety and neuroses
Voiding difficulty
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Detrusor hypotonia is usually simply ageing with the natural reduction in muscle fibres and muscle strength being enough to bring about a clinical problem
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