Female Urinary Incontinence

Question 1

What are the major risk factors for developing Urinary Incontinence?

Answer 1

Age
Parity
Menopause
Smoking
Pelvic Floor Trauma
Denervation
CT Disease
Surgery
Preg & childbirth!

Question 2

What do you want to know about incontinence?

Answer 2

• Irritation symptoms e.g. frequency, urgency, nocturia, dysuria & haematuria
• Incontinence and what type e.g. stress, urgency, coital
• Severity of incontinence
• Voiding symptoms e.g. Straining, interruption & UTIs
• QoL
• Prolapse symptoms e.g. lump, heaviness or draggin sensation
• Bowel symptoms e.g. incontinence, constipation of IBS

Question 3

What tests can you do for an incontinent woman?

Answer 3

• 3 day urinary diary
• Urine dipstick
• Exams (general, abdo, neuro, pelvic)
• Pelvic floor Assessment
• Bladder Scan (Residual volume)
• Urodynamics (if considering surgery)

Question 4

How do we grade a pelvic floor assessment?

Answer 4

Oxford Scale

Question 5

In what way’s can we manage incontinence?

Answer 5

• Lifestyle (Smoking, weight loss, healthy eating to prevent constipation, alcohol & caffeine)
• Medical
• Physio
• Surgery

Question 6

Define Stress Urinary Incontinence?

Answer 6

Intrabdominal pressure > urethral pressure –> Leakage on coughing, straining, sneezing etc

Question 7

How can we increase the closure pressure of the urethra in stress incontinence?

Answer 7

• Pelvic floor training
• Surgery
• Meds (Duloxetine - after muscle training & surgery)

Question 8

What surgery can we provide for stress incontinence?

Answer 8

Tension Free Vaginal Tape

Colposuspension

Question 9

Define Overactive Bladder Syndrome

Answer 9

Symptom complex usually due to Detrusor Overactivity:
- Urgency +/- urge incontinence
- Frequency
- nocturia

Question 10

What risk factors apply specifically to Urge Incontinence?

Answer 10

• Old
• DM
• UTI
• Smoking

Question 11

How do we manage OAB?

Answer 11

Lifestyle:
- Normalize fluids
- Lower caffeine, fizzy and chocolate
- Smoking cessation
- Wt loss

Bladder Retraining

Meds

New stuff includes botox & neuromodulation

Question 12

How does bladder retraining work?

Answer 12

Times voiding with increasing intervals to re-estrablish cortical control over the detrusor

Question 13

So what medications are available for OAB?

Answer 13

• Antimuscarinincs e.g. Oxybutinin
• TCAs