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Urinary Incontinence. NICE Guidance. Urinary incontinence. Involuntary leakage of urine Common condition Affects women of different ages Physical/psychological/social impact. Types of incontinence. Stress Urge Mixed Overactive bladder. Initial Assessment. Bladder diary Urinalysis

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Urinary Incontinence

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Urinary incontinence l.jpg

Urinary Incontinence

NICE Guidance


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Urinary incontinence

  • Involuntary leakage of urine

  • Common condition

  • Affects women of different ages

  • Physical/psychological/social impact


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Types of incontinence

  • Stress

  • Urge

  • Mixed

  • Overactive bladder


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Initial Assessment

  • Bladder diary

  • Urinalysis

  • Post-void residual urine


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Lifestyle changes

  • Modify fluid intake

  • Lose weight

  • Reduce caffeine


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Stress incontinence

  • Pelvic floor exercises

  • Duloxetine


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Stress incontinence

  • Retropubic mid-urethral tape

  • Intramural bulking agents

  • Colposuspension

  • Artificial urinary sphincter


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Urge incontinence/OAB

  • Bladder training

  • Antimuscarinic drugs

  • Intravaginal oestrogens

  • Desmopressin


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Urge incontinence/OAB

  • Botulinum toxin A

  • Sacral nerve stimulation

  • Augmentation cystoplasty


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Urgent referral

  • Microscopic haematuria >50

  • Macroscopic haematuria

  • Recurrent/persisting UTI with haematuria >40

  • Suspected pelvic mass arising from urinary tract


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Routine referral

  • Symptomatic prolapse seen at or below introitus

  • Palpable bladder after voiding


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Consider referral

  • Persisting bladder or urethral pain

  • Clinically benign pelvic masses

  • Associated faecal incontinence

  • Suspected neurological disease

  • Voiding difficulty

  • Suspected urogenital fistula

  • Previous continence surgery

  • Previous pelvic surgery or radiation


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Catheterisation

  • Persistent urinary retention causing incontinence, symptomatic infections, renal dysfunction

  • Urine contamination of wounds, pressure sores

  • Distress/disruption caused by bed/clothing changes

  • Patient preference


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A anticholinergic

B blood tests

C desmopressin

D HRT

E Intermittent catheterisation

F long term Abx

G MSU

H PFE

I prolapse

J reassurance

K refer

L sibutramine

M USS

N weight loss

Incontinent woman

Abnormal

1

Normal

2

Treat

Incontinence

persists

Resolved?

Predominantly

stress

Predominantly

urge

3

4

5

No better

6


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Answers

  • 1 G

  • 2 N

  • 3 J

  • 4 H

  • 5 A

  • 6 K


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