Female incontinence

Question 1

Ix for female incontinence

Answer 1

• bladder diaries should be completed for a minimum of 3 days
• vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
• urine dipstick and culture

• Supine stress test (valsava)
• Post-void residual measurement by either bladder scan or catherisation (positive in overflow incontinence 2ndary to retention)
• Urodynamic test
• Catheter with pressure sensor in both bladder and pressure sensor rectum (proxy for intraabdominal)
• Four lines:
○ Bladder pressure
○ Rectal pressure (abdo)
○ Third is calculation of pressure in detrusor - “pDET”
○ Uroflow from toilet

Question 2

Mx female incontinence

Answer 2

• Stress
	• Pelvic floor - at least 8 contractions performed 3 times per day for a minimum of 3 months
	• Fluid intake advice, reduce caffeine
	• Lose weight
	• Duloxetine 
	• Surgery - TVT/TOT/Colposuspension
		○ 
		○ Transobturator transvaginal tape / tensionfree vaginal tape (mesh)
		○ Intramural bulking agents
		○ Colposuspension
		○ Fascial sling (no mesh) 

• Urge
  
  • Bladder training
  • Oxybutynin - anticholinergic/antimusscarinic - risk of confusion - contraindicated in MG
  • Tolteradine
  • Solifencin
  • Botox
  • Mirabegron - beta3 agonist - detrusor relaxes - not for patients with HTN > 180

• Most patients are mixed