Female Urinary Incontinence

Question 1

Urinary incontinency definition

Answer 1

involuntary loss of urine which is objectively demonstrable and a hygienic / social problem

Question 2

Types of urinary incontinence

Answer 2

• genuine stress incontinence
• urge incontinence
  
  • detrusor instability/overactive bladder
  • mixed incontinence

Question 3

Characteristics of stress incontinence

Answer 3

• Leak occurs in spurts
• Usually occurs with predictable activity (laugh, cough, sneeze, jumping jacks)
• Leak occurs while intra-abdominal pressure is increased
• Rarely occurs when supine
• Usually occurs while upright.

Question 4

Mechanism of stress incontinence

Answer 4

involuntary loss of urine when bladder pressure exceeds urethral pressure

Question 5

Mechanism of urge incontinence

Answer 5

all caused by overactive detrusor function

Question 6

Characteristics of overactive detrusor

Answer 6

• Strong urge to void and inability to defer voiding (one pees themselves)
• Occurs with uncontrollable complete emptying
• Occurs in any position
• Associated with “bathroom mapping”

Question 7

Sx associated with overactive detrusor

Answer 7

• Urgency
• Nocturia → > 1x after going to bed
• Frequency → normal < 8 voids in 24 hours

Question 8

Definition of mixed incontinence

Answer 8

combination of both stress incontinence and detrusor instability

Question 9

Types of therapy for overactive bladder

Answer 9

• estrogen
• antispasmodics
  
  • oxybutynin
  • tolterodine
• anticholinergics
  
  • trospium
  • solifenacin
  • darifenacin
  • behavioral therapy

Question 10

Mechanism of estrogen as pharm therapy for overactive bladder

Answer 10

• Local therapy is more effective than oral → for urogenital atrophy → helps improve health of urethra tissue.
• Usually applied as a cream, as a ring, or as a pill
• Every night for 3 weeks, then 3 days per week as maintenance therapy

Question 11

Mechanism of antispasmodics as tx for overactice bladder

Answer 11

• Oxybutynin
  
  • Smooth muscle relaxant which facilitates bladder storage
  • Metabolite is active and causes more SEs
  • ADRs major concern is dry mouth and constipation
• Tolterodine
  
  • Muscarinic receptor antagonist.
  • Similar efficacy to oxybutynin with better tolerance and fewer drop outs

Question 12

Mechanism of anticholinergics as tx for overactice bladder

Answer 12

• Trospium → ammonium (quaternary compound that doesn’t cross BBB) nonreceptor selective antimuscarinic. Less SEs than antispasmodics.
• Solifenacin → muscarinic receptor (M3) antagonist. More specific, but SEs still bad
• Darifenacin → highly selective M3 receptor antagonist. Lots of SEs ? dry mouth and constipation.

Question 13

Characteristics of behavioral treatment of overactive bladder

Answer 13

• **Kegel contractions
• teach using instructions +/- perineometer
• 300 contractions/day logged in exercise tracker
• patients can produce Kegels as long as anal wink and bulbocavernosis reflexes are intact
• high success rates
  
  • Can significantly decrease stress incontinence following pregnancy
  • Can also give patients ability to control urges.