Assessment of Urinary Incontinence

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Assessment of Urinary Incontinence

• Judith Goh
• Dept Urogynaecology
• Royal Womens Hospital

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Prolapse and Incontinence

• How common?
• About 20 females 10-29 years, over 40 gt 75
  years
• About 46 women experienced or experiencing
  pelvic floor dysfunction
• Over 50 women (non-institutionalised) aged 70-74
  years complained of urinary incontinence
• About 1/4 women will undergo surgery for
  incontinence and prolapse
• MacLennan et al. BJOG 2000

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Normal Bladder Function

• 2 main functions urine storage and expulsion at
  appropriate time
• Storage at low detrusor pressures
• Void up to 7 times a day

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Management of Incontinence

• Determine cause of incontinence
• Detect related urinary tract pathology
• Individualise interpretation of evaluation
• Expectations of outcomes and management

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Causes of Urinary Incontinence

• Stress incontinence
• Urge incontinence
• Mixed incontinence
• Overflow incontinence
• Extraurethral
• Functional disorders
• Reversible

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Risk factors

• Age
• Childbearing
• Genetic, connective tissue
• Neuropathy
• Obesity
• Chronic straining

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History (1)

• Activity related/stress
• Urgency, urge incontinence
• Frequency, nocturia
• Dysuria, pain, UTI
• Voiding difficulty
• Haematuria

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History (2)

• Voiding pattern
• Fluid intake
• Use of pads/devices
• Alteration to lifestyle
• Previous treatment outcomes

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Physical examination

• General, vulval
• Gynaecological
• Pelvic organ prolapse
• Urinary incontinence
• Local neurological

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Office Investigations

• Pad test
• Postvoid residual volume
• Urinalysis
• Urinary diary

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Urinary Diary
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Investigations

• UE, BSL
• Imaging
• Urine culture, cytology
• Urodynamics
• Cystoscopy
• Dye test

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Further Evaluation

• Uncertain diagnosis
• Failure of initial therapy
• Surgery
• Haematuria
• Coexisting condition

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Urodynamics

• Designed to determine the functional status of
  the bladder and urethra.
• Components
• Uroflowmetry
• Cystometry
• Urethral closure pressure
• Others

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Urodynamics

• The interpretation requires a good knowledge base
  and experience
• UTI may be caused by UD may invalidate results

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Assessment of urinary incontinence - conclusions

• Extent and interpretation of evaluation must be
  tailored to the individual
• Not all detected conditions can be cured