By;Mr. Adeel ABBAS

Define Urinary Incontinence?

Involuntary Loss Of Urine That Can Be

Demonstrated Objectively And Is A Social

Or Hygienic Problem.

Epidemiology15% to 30%.

Male to Female Ratio 1 : 3.

Elderly.

CausesUrethral Incontinence

Non-Urethral Incontinence.

Urethral Incontinence;

1. Urethral Abnormalities

2. Bladder Abnormalities.

3. Non-Urinary Abnormalities.

Urethral Abnormalities;

•Pelvic Fracture.

•Post-Prostectomy.

•Multiparity.

•Difficult Delivery.

Bladder Abnormalities.

Cystitis.

Bladder Stones.

Bladder Tumors.

Detrusor Muscle Neuropathy.

Non-Urinary Abnormalities;

Impaired Mobility.

Non-Urethral Incontinence;

Ureteral Ectopia.

Urinary Fistula.

Classification Stress Incontinence.

Urge Incontinence.

Mixed Incontinence.

Overflow Incontinence.

Stress Incontinence Is Urinary Leakage

When Intra-abdominal Pressure Exceeds

Urethral Pressure.

Urge Incontinence Is Urinary Leakage

Caused By Rise In Intra-vesical Pressure

Secondary To Uninhibited Bladder

Contraction From Detrusor Hyperactivity.

Mixed Incontinence Is A Combination Of

Stress & Urge Incontinence.

Overflow Incontinence Is Urinary

Incontinence Caused By Bladder Atonia

Secondary Damage To The Efferent Fibers Of

The Sacral Reflex.

Clinical Features Stress Incontinence.?

Urge Incontinence.?

Nocturnal Enuresis.?

Features of Infection, Trauma, Fistula…

Clinical Features Stress Incontinence.?

Urinary Leakage During Coughing, Straining,

Etc Are Quite Specific.

Urge Incontinence.?

Inability To Maintain Urine Continence In The

Presence Of Frequent And Insistent Urges To

Void.

Nocturnal Enuresis.?

10% of 5 years Old Normal.

5% of 10 years Old Normal.

Bed-Wetting in Older Children

Abnormal.

Indicate Unstable Bladder.

Investigations?Urine Culture.IVU.Urodynamics;

Uroflowmetry.Cystometry.Postvoid Residual Volume.

Cystoscopy.MRI.Vaginal Speculum Examination.

Medical Treatment:Loose Weight.Pelvic Floor Exercise.

Surgical Treatment:Urethropexy.Artificial Sphincter.Vaginal Repair.

Management of Stress Incont:

Management of Urge Incont:Medical Treatment:

Modify Fluid Intake.Avoid Caffeine / Alcohol.Treat Underlying Cause.Anticolinergics (Oxybutynin)

Surgical Treatment:Cystoplasty.

Avoid Medications That Cause Detrusor Hypoactivity.

If Obstruction…? Treat Cause.

If No Obstruction…?Clean Intermittent Self Catheterization.

Management of Overflow Incont:

Surgery…

Management of Urinary Fistula