![]() ![]() Check perianal sensation and reflexes to rule out neurological deficits – the same nerve root supplied perianal sensation and the sphincter muscles.Perineum (look for urine leak with coughing).Examination – Abdomen (identify distended bladder).Check bowel function and other medications.Keeping a voiding diary may be useful including the volume of urine passed, frequency and any precipitating factors. A detailed history may indicate a relationship with certain activities or drugs. ![]() Botox to the bladder neck may also be considered.You should avoid giving these if there is a history of UC or glaucoma. Examples include oxybutynin and tolterodine. Often anticholinergic drugs may be used as these will reduce the activity of the autonomic nervous system (which will control bladder contraction in the lack of conscious control seen in conditions of brain damage). Drugs – there are several drugs available, although their efficacy is debateable.It might also be necessary to try aids, such as pads. Try a toilet regimen (perhaps every 4 hours) – the aim being to keep the bladder volume below that which triggers the incontinence. Often it involves a disabled patient with a CNS condition. Basically, this is very hard to treat.If there is a long history of vaginitis, and there has been no hysterectomy, consider treatment with cyclical progesterone, as this reduces the risk of uterine cancer. Test for vaginitis (inflammation of the vaginal mucosa).If this is present, then treat with estriol.Examine for spinal cord and CNS signs to determine if is it as a result of brain damage.Try limiting fluid intake and avoiding irritant foods.There is a 5% risk of incontinence or difficulty passing urine afterwards. It also means you can’t have children after you have had it done. It is more effective than a sling procedure, but is a much more serious operation. ![]()
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