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Management of Urinary Incontinence

Management of Urinary Incontinence. Depends on the patient!. Age Effect on quality of life Type of incontinence Presence of prolapse. Activity!. Sort the cards into management options for stress incontinence or overactive bladder.

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Management of Urinary Incontinence

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  1. Management of Urinary Incontinence

  2. Depends on the patient! • Age • Effect on quality of life • Type of incontinence • Presence of prolapse

  3. Activity! • Sort the cards into management options for stress incontinence or overactive bladder. • Line them up in the order that you would offer them, there may be more than one at the same time. • Of course, not every option is suitable for every patient.

  4. Stress incontinence Conservative • Lifestyle interventions • Pelvic floor exercises +/- biofeedback • Vaginal cones • Ring pessary Medical • Vaginal oestrogen • Duloxetine Surgical • TVT • Pelvic floor repair

  5. Overactive Bladder Conservative • Lifestyle interventions • Bladder retraining • Pelvic floor exercises Medical • Vaginal oestrogen • Anti-muscarinics Surgical • Sacral nerve root stimulation • Botox • Detrusor myomectomy • Augmentation cystoplasty

  6. Lifestyle Interventions

  7. Pelvic Floor Exercises • More effective if supervised • +/- biofeedback • Refer to community continence services • Vaginal cones

  8. Bladder Retraining • To re-establish cortical control over voiding • Regular voiding, gradually increasing intervals. • Using distraction and relaxation techniques • Bladder diary will show improvement

  9. Ring Pessary • Anterior prolapse predisposes to stress incontinence • Changed every 4-6 months • Conservative option

  10. Anti-muscarinic medication • Oxybutinin 2.5mg, 5mg • Tolterodine (Detrusitol), Trospium (Regurin) • CI: myasthenia gravis, significant bladder outflow obstruction or urinary retention, severe ulcerative colitis, toxic megacolon, and in gastro-intestinal obstruction or intestinal atony. • SE: dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention) • Try several before giving up

  11. Other medications Duloxetine SNRI Increases urethral closure pressure 20-40mg bd SE: GI disturbance, headache, dry mouth, rarely suicidal ideation Vaginal Oestrogens e.g. Ovestin, Vagifem, Ortho-gynest All postmenopausal women not on HRT Oestrogen breaks advised (?endometrial Ca risk)

  12. Surgery for Stress Incontinence • Tension-free Vaginal tape (TVT) • Pelvic Floor Repair

  13. Surgery for Overactive Bladder • A last resort! • Sacral nerve root stimulation • Botox • Detrusor Myomectomy • Augmentation Cystoplasty

  14. Any Questions?

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