URINARY
INCONTINENCE
DEPARTMENT OF UROLOGY
Dr. Imran Malik
LEARNING OBJECTIVES
Definition
Risk factors and Etiologies
Types
Investigation
Role of Urodymanics
Management
Complications
DEFINATION?
Involuntary Leakage
of Urine
URINARY INCONTINECE
❖ Common
❖ Treatable
❖ Significant Effect on Quality of Life
ANATOMICAL STRUCTURES OF THE
LOWER URINARY TRACT SYSTEM
➢ The bladder and bladder Neck
➢ The Urethral Sphincter
➢ Pelvic floor muscles
NERVE SUPPLY OF BLADDER
SYMPATHETIC (Hypograstic nerve T12–L2)
It cause relaxation of detrusor muscle
It promotes urinary filling
PARASYMPATHETIC (Pelvic nerve S2-S4)
It cause contraction of detrusor muscle
It stimulates micturition
SOMATIC (Pudendal nerve S2-S4)
It gives voluntary control over micturition by
innervating external urethral sphincter
Urethral Sphincters
INTERNAL SPHINCTERS EXTERNAL SPHINCTERS
Situated at the base of Situated at the
the bladder neck. veruumontanum
(membranous urethra)
Circular smooth muscle
layer Skeletal muscle layer
Involuntary control (under Voluntary control
autonomic control)
FUNCTIONS OF THE PELVIC FLOOR
PELVIC FLOOR FORMED BY LEVATOR ANI MUSCLES (LARGEST
COMPONENT) AND COCCYGEUS MUSCLE
FORMS A “SLING-LIKE” SUPPORT FOR THE LOWER PELVIC ORGANS
HELP IN MAINTAINING EXTERNAL SPHINCTER CLOSURE
CAUSES OF URINE INCONTINENCE
• D DELIRIUM
• I INFECTION
• A ATROPHIC VAGINITIS
• P PSYCHOLOGICAL
• P PHARMACOLOGIC AGENTS
• E ENDOCRINE, EXCESSIVE UO
• R RESTRICTED MOBILITY
• S STOOL IMPACTION
TYPES OF URINARY
INCONTINENCE
❑ Stress UI (SUI)
❑ Urge UI (UUI)
❑ Overflow UI
[Link] Incontinence
It is involuntary loss of urine during actions such as
coughing, sneezing, lifting that put abdominal pressure on
the bladder
It occurs when the sphincter and pelvic muscle is
weakened
In women, physical changes resulting from pregnancy,
childbirth and menopause can cause stress incontinence
[Link] incontinence
It occurs in patient who have a strong sudden
involuntary urge to urinate that leads to leakage of
urine also called overactive bladder.
It can be found in patient with urinary infection
neurogenic bladder dysfunction, such as multiple
sclerosis, Parkinson disease, stroke or spinal injury or it
can be idiopathic.
[Link] incontinence
It is constant dribbling of urine usually associated with
increased frequecy and in small amount
Overflow incontinence occurs with chronic urinary
retention
This type of incontinence may occur in people with a
damaged bladder, nerve damage from diabetes and in
men with enlarge prostate gland.
DIAGNOSTIC EVALUATION
History
Physical and Systemic examination
Investigations
INVESTIGATIONS
Bladder Diary
Urine DR Culture
Ultrasound KUB+Pre and Post void Residual urine
UFM (Uroflowmetry)
URODYNAMICS
BLADDER DIARIES
Fluid Intake
Frequency of urine
Volume of Urine voided
Incontinent episodes
Pad usage
Degree of urgency
UROFLOWMETRY
Urine flow rate or urinary flow rate is the volumetric
flow of urine during urination.
It is a measure of the quantity of urine excreted in a
specified period of time (per second or per minute).
URODYNAMICS
Urodynamics testing in most and in all patients whom
surgical intervention is proposed.
The principle is to artificially stimulates bladder filling
and emptying while obtaining pressure measurements.
A pair of catheter placed in a bladder continuously
filled with fluid at the rate of 50ml/min and
intravesical pressure record throughout.
Second catheter placed intravaginally or intrarectal
to obtain intra abdominal pressure, so we can obtain
the true detrusor pressure.
Normal bladder capacity 400-500ml
Intravesical pressure should be less than 15cmH20
during filling phase.
Flow rate in between 20-25ml/s
MANAGEMENT
In three categories:
1. Behavioural
2. Pharmacological
3. Surgical
BEHAVIOURAL TREATMENT
Life style modification
Weight loss, stop smoking, avoid
constipation, modify fluid intake
avoid stimulants (caffein, alcohol) and
bladder training (in UUI)
Pelvic floor muscle training/Kegel Exercise (SUI)
PHARMACOLOGICAL TREATMENT
SUI
Duloxetine (serotonin and non adrenaline
reuptake inhibitor)
It increase sphincter muscle activity during
bladder filling
UUI
Anticholinergic
It inhibits bladder contractions
SURGICAL TREATMENT
SUI
Urethral bulking agent
Suburethral slings
Artificial Urinary Sphincters
SURGICAL TREATMENT
UUI
Bladder augmentation
Botulinum toxin A (BTX-A) Injection
OVERFLOW INCONTINENCE
Pharmacological Treatment
BPH ---- Alpha blockers
Surgical Treatment:-----TURP
COMPLICATIONS:
Hydronephrosis
Vesicoureteral reflux
Renal failure
Urinary tract infection
Stone disease
Bladder cancer
THANK YOU
MCQs
Which of the following is the definition of stress urinary
incontinence (UI)?
a. Leakage of urine with urgency
b. Leakage of urine with an increase in intra-
abdominal pressure
c. Leakage of urine while asleep
d. Leakage of urine with urgency and effort
e. Leakage of urine without being aware of it
Which of the following symptoms is not considered a
bladder storage symptom?
a. Frequency
b. Urgency
c. Hesitancy
d. Nocturia
Which of the following is not a treatment for urgency
urinary incontinence (UUI)?
a. Bladder training
b. Antimuscarinics
c. Duloxetine
d. Botox