URINARY INCONTINENCE

DEFINITION:-
 Urinary incontinence is defined as the involuntary loss of
urine.
 It is increasingly prevalent as the ageing population
expands.
 It affects an individual’s physical, psychological and
social well-being and is associated with a significant
reduction in quality of life.
Types:-
 Urinary incontinence is classified according
to pathophysiological concepts rather than
symptomatology:-
 Fistula (true incontinent).
FISTULA (TRUE INCONTINENT)
 A urinary fistula is an abnormal opening between the
urinary tract and the outside.
 True or total incontinence is one of the extra-urethral
types of incontinence.
 An acquired fistula is the most common cause of True or
total incontinence, either: vesico-vaginal fistula (fistula
between the bladder and the vagina. It is the common
cause of true incontinence) or uretero-vaginal fistula
(fistula formed between the ureter(s) and the vagina).
 True or total incontinence characterized by continues
leakage.
CAUSES:-
 Urinary fistulae have obstetric and gynecological causes:
 The former include obstructive labor with compression
of the bladder between the presenting head and the bony
wall of the pelvis.
 The gynaecological causes are associated with pelvic
surgery or pelvic malignancy or radiotherapy.
 Surgical trauma as might be seen after hysterectomy,
radical pelvic surgery or pelvic repair.
 But it can be due to a malignant fistula, e.g., cancer
cervix or cancer urinary bladder, rarely cancer vagina.
Infection, is seen only in destructive infections as TB of
the urinary bladder.
 Rarely, the cause may be congenital deficit.
Symptoms:-
 The patient often report painless unremitting urinary
incontinence. This is also called total, or continuous,
incontinence. Urinary incontinence may be exacerbated
during physical activities, leading some women to
confuse this with stress incontinence.
 Diagnose:-
 is usually on the basis of painless and continuous vaginal
leakage of urine after birth or following pelvic surgery or
irradiation.
 History of incontinent:
 Immediately after difficult labor (traumatic).

 Or after several days after labor or surgery.

 Palpation of anterior vaginal wall (fistula can be

palpable).
TREATMENT:-
 Whatever the cause, the fistula must be accurately
localized.
 It can be treated by primary closure or by surgery and
can be delayed until tissue inflammation and oedema
have resolved at about 4 weeks.
REFERENCES:-
 Monga.A and Dobbs.S (2011).Gynaecology by
ten teachers. 19th ed.
 https://www.ncbi.nlm.nih.gov