Transcript Urinary Incontinence

Urinary Incontinence (UI)
Management in Family Practice
References:
Can Fam Physician 2003;49:611-618.
Can Fam Physician 2003;49:602-610.
SOGC Clinical Practice Guidelines. No. 127, April 2003.
To do:
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Info
Types of Incontinence
What to do in office
Treatment
When to refer
Info
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1.5 million Canadians
12% of women, 2% of men >55
Affects Quality of Life
Majority can be managed by Family
Physician
Types of Incontinence
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Stress
Urge
Mixed
Overflow
Stress Incontinence
 Most common
 Loss of urine on physical exertion or
increases in intra-abdominal
pressure.
 Usually no nocturia (helps distinguish
from urge incontinence)
Urge Incontinence (overactive
bladder)
 Loss of urine with strong desire to
void. Frequency and nocturia are
common
 Pure urge incontinence is least
common (3% adult women)
Mixed UI (urge + stress)
 Loss of urine with both urge and
increases in abdominal stress.
Overflow
 Associated with bladder distention or
retention; poorly contractile detrusor
or outlet obstruction
 Chronic retention is usually painless
 Can be confused with stress
incontinence because leakage can
occur with increase abdominal
pressure
What to do in Office?
 Ask about it on annual
 precipitating factors,
amount, frequency,
protective measures
(pads, clothing
changes), Quality of
Life
 Fluid Intake, caffeine,
HS fluids?, previous
surgeries, smoke, ? Sx
of UTI, constipation
 Meds: Ace (cough),
diuretics, alphablockers
 Causing retention:
hypnotics,
antipsychotics,
narcotics,
anticholinergics
Voiding diary
Basic Physical Exam/Labs
 Neurological exam
 Urinary Stress Test
 Speculum and
Bimanual Pelvic
 Urine Dip/R&M
Treatment
1. Lifestyle: fluid/caffeine, UTI,
constipation, void regularly, lose
weight, stop smoking
2. Pelvic Floor Strengthening: benefit urge,
stress, and mixed UI. Success in 50-90% of patients
3. Bladder Training (Urge Suppression
or scheduled voiding)
Kegel (Pelvic Floor Muscle)
Exercises
 Squeeze (as if
stopping urination)
 Hold for 5s, relax for
10s. Repeat x10 TID.
 15 contractions TID
 20 contractions QID
+ 20 whenever
Specific Treatment for Stress
Incontinence
 Pessary: for Stress Incontinence +/Prolapse
Specific Treatment for Mixed/Urge
 Muscarinic Receptor Antagonists
OXYBUTYNIN: Ditropan® XL 5 mg
Transdermal: Adults: Apply one 3.9 mg/day patch twice weekly
(every 3-4 days)
TOLTERODINE: Detrol® 2 mg BID or 4 mg Daily of Long
Acting (LA)
When to Refer
 No or partial response to conservative
measures
 Previous prolapse surgery
 Previous continence surgery that has failed
 Severe pelvic organ prolapse
 Voiding dysfunction with high postvoid
residual urine (with or without
complications: recurrent UTI,
hydronephrosis)