![]() ![]() Urodynamic tests are a way of objectively assessing the presence and severity of urinary symptoms. It is not always required where the diagnosis is possible based on the history and examination. Urodynamic testing can be used to investigate patients with urge incontinence not responding to first-line medical treatments, difficulties urinating, urinary retention, previous surgery or an unclear diagnosis. Post-void residual bladder volume should be measured using a bladder scan to assess for incomplete emptying. Urine dipstick testing should be performed to assess for infection, microscopic haematuria and other pathology. There should be a mix of work and leisure days. 5: Strong contraction, a firm squeeze and drawing inwardsĪ bladder diary should be completed, tracking fluid intake and episodes of urination and incontinence over at least three days.3: Moderate contraction with some resistance.This can be graded using the modified Oxford grading system: The strength of the pelvic muscle contractions can be assessed during a bimanual examination by asking the woman to squeeze against the examining fingers. Try to differentiate between urinary leakage with coughing or sneezing ( stress incontinence), and incontinence due to a sudden urge to pass urine with loss of control on the way to the toilet ( urge incontinence).Īssess for modifiable lifestyle factors that can contribute to symptoms:Įxamination should assess the pelvic tone and examine for:ĭuring the examination, ask the patient to cough and watch for leakage from the urethra. Neurological conditions, such as multiple sclerosisĪ medical history should distinguish between the types of incontinence.Previous pregnancies and vaginal deliveries.Women with suspected overflow incontinence should be referred for urodynamic testing and specialist management. Overflow incontinence is more common in men, and rare in women. ![]() It can occur with anticholinergic medications, fibroids, pelvic tumours and neurological conditions such as multiple sclerosis, diabetic neuropathy and spinal cord injuries. Chronic urinary retention results in an overflow of urine, and the incontinence occurs without the urge to pass urine. Overflow incontinence can occur when there is chronic urinary retention due to an obstruction to the outflow of urine. It is crucial to identify which of the two is having the more significant impact and address this first. Mixed incontinence refers to a combination of urge incontinence and stress incontinence. The typical description of stress incontinence is urinary leakage when laughing, coughing or surprised. This allows urine to leak at times of increased pressure on the bladder. ![]() Stress incontinence is due to weakness of the pelvic floor and sphincter muscles. When the muscles of the pelvic floor are weak, the canals become lax, and the organs are poorly supported within the pelvis. There are three canals through the centre of the female pelvic floor: the urethral, vaginal and rectal canals. The pelvic floor consists of a sling of muscles that support the contents of the pelvic. This can have a significant impact on their quality of life, and stop them doing work and leisure activities. Women with urge incontinence are very conscious about always having access to a toilet, and may avoid activities or places where they may not have easy access. The typical description is of suddenly feeling the urge to pass urine, having to rush to the bathroom and not arriving before urination occurs. Urge incontinence is also known as overactive bladder. Urge incontinence is caused by overactivity of the detrusor muscle of the bladder. Establishing the type of incontinence is essential, as this will determine the management. There are two types of urinary incontinence, urge incontinence and stress incontinence. Urinary incontinence refers to the loss of control of urination. ![]()
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