Incontinence in Women Dr Sanjay Garg Senior Consultant Urology Dr Vijayant G Gupta Asso Consultant Urology Urinary incontinence in the female Involuntary loss of urine which is objectively demonstrable amp is a social or hygienic problem ID: 595749
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Female Urology &Incontinence in Women
Dr Sanjay GargSenior Consultant UrologyDr Vijayant G GuptaAsso Consultant UrologySlide2
Urinary incontinence in the female
Involuntary loss of urine which is objectively demonstrable & is a social or hygienic problem.
Stress incontinence
:
Involuntary expulsion of urine under conditions of stress like rise of intra-abdominal pressure due to coughing, sneezing , laughing or lifting weights.Slide3
True incontinence – Continuous LeakageUrge incontinence
- it is associated with strong desire to void Stress incontinence-leaking on stressOverflow incontinence-It is sequel of prolonged and neglected retention TypesSlide4
Prevalence of Problem
Upto 57% in women 45-64 yrs.
14% in general population.
Common condition, but rarely life threatening
Adverse effect on quality of life
Embarrassment and anxiety.Slide5
Definition of SUI
Stress urinary incontinence (SUI) is defined by the international continence society (ICS) as the complaint of involuntary leakage of urine on effort or exertion, or on sneezing or coughing.Slide6
Causes of urinary incontinence
Genuine stress incontinenceUrinary loss which occurs with sudden elevation of the intra abdominal pressure without detrusor
contraction
Detrusor
instability
Retention with overflow incontinence
Urogenital
fistula
Urethral
diverticulumSlide7
Grading of SUI
Grade 0Incontinence without leakageGrade 1Incontinence with only severe stress, such as coughing, sneezing, and joggingGrade 2
Incontinence with moderate stress, such as fast walk, going up and down the stairs
Grade 3
Incontinence with mild stress such as standingSlide8
Etiology
Age Multiparty Obesity Smoking
Prolapse
Constipation
Pregnancy and
puerperium
Athletes
Slide9
Investigations
GeneralUrine-
Routine/microscopy
, c/s
Frequency/volume chart or urinary diary.
Pad test.
Advanced
Uroflowmetry
- 15-25ml/sec
Cystometry
Urethral pressure
profilometry
Cystourethroscopy
Micturition
cystographySlide10
Stress Test
Excellent method of demonstrating objectively the presence of SUISteps
Catheterisation
Urine sample is sent for culture
250 ml warm saline instilled into the bladder
Leakage noted in sitting and supine position
Net weight gain of 2g or more is indicative of GSISlide11Slide12
Bonneyʼs test
Bonney testAbsence of leakage of urine following bladder neck elevation is indicative of beneficial
outcomefollowing
surgical repairSlide13
Management
ConservativeFluid intake and voiding habitsWeight loss
Physiotherapy
Reduce
caffein
intake and smoking
Drugs -
Dapoxetine
Intraurethral
and vaginal devices
Electric stimulation
Surgical
Slide14
Fluid Management
Fluid intake and voiding habits
Trials have been demonstrated that increase in fluid intake increases the episodes of incontinence thus decreasing the fluid intake is helpful in for patient with high fluid consumption
Voiding prior to
strenous
activity beneficial in mild SUISlide15
Pelvic Floor Exercises
Kegel
described the PFM exercises in 1948 for female UI
Reported success rate is more than 80%
Offer a trial of supervised pelvic floor muscle training of at least 3 months' duration as first-line treatment to women with stress or mixed UI.
[2006]
Pelvic floor muscle training should comprise at least 8 contractions performed 3 times per day for 3-6 month.
[2006]Slide16
Weight lossSeveral studies shows association between obesity and development of incontinence a study examining women who had lost weight as a result of bariatric surgery found that there was significant decrease in both subjective and objective SUI and UUISlide17
SNRI
DuloxetinePromising Drug – Increases Bladder Neck ToneOne study conduct in north america showed incontinence episodes decreased by 50% in duloxetine group versus 27% in placebo groupSlide18
Anti Cholinergic
Roliten/SolifineReduces Bladder Contraction/Increases CapacitySlide19
Electric Stimulation
Electric stimulationTried if SUI is caused by denervation of pudendal
nerve during delivery
Useful in
women
with weak pelvic floor musclesSlide20Slide21Slide22
Surgery
Suspension Procedures (For Hypermobile Bladder Neck)
Burch
Colposuspension
Retropubic
Slings –
Artifical
Mesh or Rectus Sheath
Slings
Mid Urethral Slings (Gold Standard)
Artificial
Urinary SphinctersSlide23
SlingSlide24
Complications of Surgery
Injury to bladder
Mesh Infection/ Migration
Hyper Continence – Urine Retention
Bleeding/ Injury to
Iliacs
Nerve Injuries – Chronic NeuralgiaSlide25
Take Home Message
Stress Urinary Incontinence is a major problem in the women of India
It is
underidentified
and undertreated
Cause of Major Embarrassment and Poor Quality of life in womenSlide26
Effective long term treatment of this problem existsInvolve your
Urologist colleagues in the management of these problemsThank YouSlide27Slide28