Urinary Incontinence Involuntary loss of urine that is objectively demonstrable and is a social or hygienic problem. Affects physical, psychological, social well being → Reduce quality of life Prevalence, ↑ with age Common in institutionalized women, those in residential nursing homes

Some definitions… Stress incontinence is loss of urine on physical effort Urge Incontinence is an involuntary loss of urine associated with a strong desire to void. Overflow Incontinence occurs without any detrusor effort when the bladder is over-distended. Urgency is a sudden desire to void Frequency is passing of urine seven or more/day or being awoken from sleep more than once a night to void.

Classification of Incontinence EXTRA URETHRAL CAUSES Congenital causes Fistula URETHRAL CAUSES Urethral Sphincter Incompetence (Urodynamic stress Incontinence) Detrusor overactivity/Unstable bladder (Nueropathic or non-nueropathic) Retention with overflow Congenital causes Miscellaneous

2B: FISTULA Abnormal opening between the urinary track and outside. Obstetric cause: Obstructive labour with compression of bladder between presenting head and bony pelvis Gynecological cause: AW pelvic surgery, radiotherapy, pelvic malignancy Treated by primary closure or surgery

INVESTIGATIONS Urine C&S- tro Infections Pad test Measure Postvoidal Residual Volume by bladder ultrasound or urethral catheter >100mL in more than one occasion→+ Cough Stress Test. 250mL into bladder Abdominal leak point pressure

Urodynamic studies Cystogram Cystoscopy Uroflowmetry. Bladder outlet obstruction Cystometry. Detrusor activity, differentiate involuntary detrusor contraction or increase intraabdominal pressure Cystogram Stress incontinence, Cystocele, Sphincter activity, fistula Cystoscopy Tumors, stones

Treatment Palliative – Fluid restriction, Protective perineal pads, Bladder retraining, Pelvic Floor exercise (Kegel) Devices – Weighted vaginal cones, Vaginal pessaries, contraceptive diaphragms Surgery – to restore the proximal urethra and bladder neck to zone of intraabdominal pressure transmission and to increase urethral resistance Colposuspension Operation, Artificial Sphincter