10. Urinary Incontinence

Question 1

What affect does an upper motor neurone lesion have on neurological control of micturition?

Answer 1

Reduced sympathetic inhibition of detrusor muscle contraction, leading to high pressure detrusor muscle contractions and poor coordination with sphincters (contract leading to increased pressure during voiding - detrusor sphincter dyssynergia).

Question 2

What affect does a lower motor neurone lesion have on neurological control of micturition?

Answer 2

Lesion to T12/L1 or below.
Reduced pars sympathetics innervation to bladder causing low detrusor pressure and so large residual urine, with or without overflow incontinence.
Also reduced perianal sensation and lax anal tone.

Question 3

What are the 3 classifications of lower urinary tract symptoms and give an example of each.

Answer 3

Storage - eg frequency, urgency, nocturia, incontinence.
Voiding - eg slow stream, splitting or spraying, intermittency, hesitancy, straining, terminal dribble.
Post-micturition - post-micturition dribble, feeling of incomplete emptying.

Question 4

What impacts can urinary incontinence have on the patient?

Answer 4

Impact on quality of life.
Social exclusion.
Sense of shame.

Question 5

What is stress urinary incontinence?

Answer 5

The complaint of involuntary leakage on effort or exertion, or on sneezing or coughing.

Question 6

What is urge urinary incontinence?

Answer 6

The complaint of involuntary leakage of urine accompanied by or immediately proceeded by urgency.

Question 7

What is mixed urinary incontinence?

Answer 7

The complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing.

Question 8

What is overflow incontinence?

Answer 8

Urinary retention leading to overflow.

Question 9

What is overactive bladder syndrome?

Answer 9

Bladder contraction not under normal control, occurring when the bladder isn’t full. Included mixed urinary incontinence and urge urinary incontinence, but more commonly causes urgency, frequency and nocturia.

Question 10

Which type of urinary incontinence is most common?

Answer 10

Stress urinary incontinence.

Question 11

Name 4 risk factors for urinary incontinence.

Answer 11

Obs and gynaecologist - eg pregnancy, childbirth, pelvic surgery, pelvis prolapse.
Predisposing - eg race, family predisposition, anatomical abnormalities, neurological abnormalities.
Promoting - eg menopause, drugs, UTI, increased intra-abdominal pressure, cognitive impairment, age, obesity, co-morbidities.

Question 12

Name 2 lifestyle interventions for a patient who wants to manage their urinary incontinence conservatively.

Answer 12

Modify fluid intake.
Weight loss.
Stop smoking.
Decrease caffeine intake.
Avoid constipation.
Timed voiding - fixed schedule.

Question 13

Name one surgery for males and one for females to treat stress urinary incontinence.

Answer 13

Females - low-tension vaginal tapes.

Males - artificial urinary sphincter.

Question 14

What would you recommend as initial management of stress urinary incontinence?

Answer 14

Pelvic floor muscle training - 8 contractions 3 times a day for at least 3 months.

Question 15

What would you recommend as initial management of urge urinary incontinence?

Answer 15

Bladder training - schedule of voiding, every hour during the day, increasing intervals by 15-30 minutes a week until interval of 2-3 hours reached.

Question 16

What can be used pharmacologically to manage urge urinary incontinence?

Answer 16

Anticholinergics - inhibition of detrusor muscle contraction. Side effects at other M receptors at different sites.
Beta3-adrenoceptor agonist - increases bladders capacity to store urine.