15: Incontinence

Question 1

Hx woman with incontinence

Answer 1

• Incontinence: how much, how often impact on QoL, precipitating factors
• Environmental factors
• Pain
• Associated symptoms: sensation of dragging, N&V, other urinary symptoms, bowel function, fevers
• Obs hx: previous deliveries, birth weight, parity
• Gynae hx: bleeding, smears
• PMHx: asthma, cough, diabetes, neurological
• Past surgery or radiotherapy
• SH: smoking

Question 2

Stress vs urge incontinence

Answer 2

Stress = involuntary leakage with inc. intra-abdominal pressure

Urge = sudden overwhelming urge to PU followed by emptying of a large volume

Question 3

Mx for stress and urge

Answer 3

Stress = pelvic floor exercises, surgical for severe incontinence (support neck or urethra)

Urge: bladder retraining, anticholinergics (oxybutynin), bedside commode, intermittent catheterisation

Question 4

Ix for incontinence

Answer 4

Bladder diary

• mL of each void and timing, leakage, pads used, fluids taken time and volume
• Lab: urine (dipstick and MSU)
• Imaging: urodynamic for uncertain dx, bladder scan ?retention