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Dr. Nedaa Bahkali 2012.  Urinary incontinence is defined as involuntary leakage of urine.

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Presentation on theme: "Dr. Nedaa Bahkali 2012.  Urinary incontinence is defined as involuntary leakage of urine."— Presentation transcript:

1 Dr. Nedaa Bahkali 2012

2  Urinary incontinence is defined as involuntary leakage of urine.

3  Stress urinary incontinence (SUI): involuntary urine leakage on exertion or with sneezing or coughing.  Urge urinary incontinence: women have difficulty postponing urination urges and generally must promptly empty their bladder on cue and without delay. If urge urinary incontinence is objectively demonstrated by cystometric evaluation, the condition is known as detrusor overactivity (DO).

4  Mixed urinary incontinence : When both stress and urge components are present, it is called.

5  Prevalence of %.  Among women with urinary incontinence, the most common condition is stress incontinence, which represents 29 to 75 %of cases. Detrusor overactivity accounts for up to 33 % of incontinence cases. whereas the remainder is attributable to mixed forms.

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7  Detrusor muscle  External and Internal sphincter  Normal capacity cc  First urge to void 150cc

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10 Storage Reflex

11 Micturition Reflex

12 o Age o Pregnancy o Childbirth o Menopause o Hysterectomy o Obesity o Chronically increased abdominal pressure Chronic cough Constipation Occupational risk o Smoking

13  Pressure Transmission  Urethral Support

14  In an ideally supported urogenital tract, increases in intra-abdominal pressure are equally transmitted to the bladder, bladder base, and urethra.  In women who are continent, increases in downward-directed pressure from cough, laugh, sneeze, and Valsalva maneuver are countered by supportive tissue tone provided by the levator ani muscle and vaginal connective tissue.

15  In those with a weakened supportive "backboard", however, downward forces are not countered.  This leads to funneling of the urethrovesical junction, a patent urethra, and in turn, urine leakage.

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17  Urethral support is integral to continenc (1) ligaments along the lateral aspects of the urethra, termed the pubourethral ligaments; (2) the vagina and its lateral fascial condensation; (3) the arcus tendinous fascia pelvic; (4) levator ani muscles.  With loss of urethral support, the urethra's ability to close against a firm supportive backboard is diminished.

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21  History : Duration, severity, symptoms, previous treatment,(Urinary Frequency, Urinary Retention, volume of urine lost, Postvoid dribbling is classically associated with urethral diverticulum) medications, Past medical hx, GU surgery, Ob hx  Voiding Diary

22 Urge Incontinence Stress Incontinence Symptom No Yes Urgency No Yes Frequency with urgency Yes No Urine leakage with increased intra-abdominal pressures smallLarge Amount of urinary leakage with each incontinence episode YesOften No Ability to reach the toilet in time following an urge to void Seldom Usually Waking to void at night

23  Diuretics  Anticholinergics - antihistamines, antipsychotics, antidepressants  Seditives/hypnotics  Alcohol  Narcotics  α -adrenergic agonists/antagnists  Calcium channel blockers

24  General Inspection and Neurologic Evaluation evidence of atrophy. neurologic evaluation of the perineum:  bulbocavernosus reflex  normal circumferential anal sphincter contraction, colloquially called an "anal wink",

25  Pelvic Organ Prolapse Evaluation

26  Q-Tip Test

27  Urinalysis and Culture  Postvoid Residual  Cystometrics  Uroflowmetry

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29  Conservative/Nonsurgical: Pelvic Floor Strengthening Exercises Pelvic Floor Muscle Training (PFMT)

30  Electrical Stimulation  Biofeedback Therapy  Dietary  Scheduled Voiding  Estrogen Replacement

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32  Medications: Pharmaceutical treatment plays a minor role in the treatment of women with SUI. imipramine is reasonable to aid urethral contraction and closure. Recently, duloxetine a selective serotonin and norepinephrine reuptake inhibitor, has been evaluated for the treatment of SUI

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34  Periurethral Bulking Agents

35  Retropubic Urethropexy  Pubovaginal Slings  Midurethral Slings

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37  Antimuscarinics: tertiary amines that act to block the muscarinic receptors in response to acetocholine First line  Oxybutinin (Ditropan)  Tolteridine (Detrol)

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