6. True Incontinence
• Urine escapes continuously by day and by
night.
• Caused by:
– Vesicovaginal fistula.
– Ectopia vesica.
7. False Incontinence
• Involuntary loss of urine following
over distension of the bladder.
• Causes:
– After vaginal delivery - if epidural anesthesia
used.
– Diabetes
– Neurological diseases
– Genital prolapse
8. Stress Incontinence
• Involuntary escape of few drops of urine
with increased intra-abdominal pressure as
during straining, sneezing, coughing,
laughing etc
9. DEGREES OF STRESS INCONTINENCE
Grade I
Incontinence only with severe stress –
coughing, sneezing.
Grade II
Incontinence with moderate stress - rapid
movement or walking up and down stairs
Grade III
Incontinence with mild stress - standing
10. Urge Incontinence
• Feels the desire to micturate passes
urine involuntarily before reaching
restroom.
• Due to irritability of the bladder muscle.
12. Diagnosis
Stress Test
• Bladder must be moderately full.
• Patient in the lithotomy- two labia
separated- asked to cough.
• If urine escapes- incontinent.
• If still no urine escapes, the test is
repeated while the patient is standing
with the legs separated.
13. Bonney test
• if incontinence is due
– descent of bladder neck
– weakness of sphincter.
• The index and middle fingers are placed
on both sides of the urethra to elevate
the bladder neck upwards.
14. • If no urine escapes - incontinence is due
to descent of the bladder neck.
• if urine still escapes - weakness of the
sphincter.
15. Cotton-Tip Applicator Test
A sterile applicator with a small piece of
cotton at its tip is introduced to reach the
bladder neck.
The angle between the applicator
and the horizontal is measured.
16. The patient then strains maximally
using the Valsalva manoeuvre.
This causes descent of the bladder neck
and upward movement of the applicator
producing a new angle with the
horizontal.
17. Cystourethroscopy
• To exclude lesions in the urethra and
bladder.
• The bladder neck is examined.
• It should close in response to straining.
• It opens in case of stress
incontinence
18. • A radio-opaque dye is injected by a
catheter into the bladder.
• On straining, the lateral view will show
absence of the posterior urethrovesical
angle in more than 90% of cases.
• Funneling of the bladder neck in the
antero- posterior view may be seen in
some cases.
• The procedure is recorded on video
tape (video Cystourethrography) to
facilitate diagnosis and for education
purposes
24. • Vaginal cones
– A set consists of 5 or 9 cones.
– Patient inserts the cone in the vagina and
keeps it for 15 minutes twice daily.
– If this succeeds she inserts the next cone.
– This improves the tone of the pelvic floor
muscles.
25. • Oestrogen therapy for menopausal
patients.
• Alpha-adrenergic stimulants - stimulate
contraction of the internal urethral
sphincter, e.g. ephedrine.
• Large vaginal diaphragms -
support the bladder neck.
26. • Reduction of weight - reduce intra-
abdominal pressure.
• Stop caffeine (to avoid diuresis)
and smoking (to avoid coughing)
• Injection of Teflon or bovine collagen in
the submucosal layer in the region of
the bladder neck.
29. Impaired bladder emptying
• In patients with overflow incontinence due to
bladder outflow obstruction – prostatectomy.
• Due to neurogenic bladder dysfunction – CISC
33. Bladder substituition
• Principle- creation of low pressure, large
capacity reservoir.
• Any segment of bowel isolated with its
vascular pedicle.
• Anastomosed to the bladder remnant at
fundus above trigone.
• Ureters reimplanted into the bowel segment.
34.
35. Summary
• Consevative
– Pelvic floor muscle and Bladder training
• Devices for collection
– External penile condom
– Indwelling urethral or suprapubic catheter
