Female Urinary Incontinence

Question 1

What nerve is responsible for storage of urine in the bladder?

Answer 1

Hypogastric nerve (T10-12) sympathetic

Question 2

What nerve is responsible for voiding of urine?

Answer 2

Pelvic nerve (S2-4) parasympathetic

Question 3

What nerve is responsible for voluntary voiding of urine?

Answer 3

Pudendal nerve (S2-4) somatic

Question 4

What process occurs when the bladder empties?

Answer 4

Detrusor contraction

Urethral relaxation

Question 5

What is urinary incontinence?

Answer 5

Any involuntary leakage or urine

Question 6

What is stress urinary incontinence (SUI)?

Answer 6

Involuntary leakage on effort or exertion, on sneezing or coughing

Question 7

What is urge urinary incontinence (UUI)?

Answer 7

Involuntary leakage accompanied by or immediately preceded by urgency

Question 8

What is mixed urinary incontinence (MUI)?

Answer 8

Involuntary leakage accompanied by or immediately preceded by urgency and on effort, exertion, sneezing or coughing

Question 9

What is the impact of urinary incontinence?

Answer 9

Impair quality of life
Reduce social relationships and activities
Impair emotional and psychological well-being
Impair sexual relationships
Embarrassment and diminished self-esteem

Question 10

What are the risk factors for urinary incontinence?

Answer 10

Age 
Parity 
Menopause 
Smoking 
Medical problems 
Increased intra abdominal pressure 
Pelvic floor trauma 
Denervation
Connective tissue disease 
Surgery

Question 11

What medical conditions are associated with urinary incontinence?

Answer 11

Diabetes 
Anti-HTN medications 
Glaucoma 
Heart/kidney/liver problems 
Cognitive problems 
Antidepressants 
Antipsychotics

Question 12

What are the irritation symptoms of incontinence?

Answer 12

Urgency 
Increased daytime frequency 
Nocturia 
Dysuria 
Haematuria

Question 13

What are the voiding symptoms associated with incontinence?

Answer 13

Straining to void
Interrupted flow
Recurrent UTI

Question 14

What are the bowel symptoms associated with incontinence?

Answer 14

Anal incontinence
Constipation
IBS
Faecal evacuation

Question 15

What should be included to fully assess a patient?

Answer 15

3 day urinary diary

Urine dipstick

Question 16

What investigations should be considered for incontinence?

Answer 16

Urinalysis
Post voidal residual volume assessment
Urodynamics

Question 17

How does stress incontinence occur?

Answer 17

When intra-abdominal pressure exceeds urethral pressure resulting in leakage

Question 18

What are the management options for incontinence?

Answer 18

Lifestyle changes
Medical treatments
Physiotherapy
Surgery

Question 19

What can be done to increase urethral closure pressure?

Answer 19

Pelvic floor muscle training
Surgery
Pharmacological agents

Question 20

What lifestyle changes can be made to improve incontinence?

Answer 20

Stop smoking
Lose weight
Eat more healthily to avoid constipation
Stop drinking alcohol and caffeine

Question 21

How does pelvic floor muscle training improve incontinence?

Answer 21

Reinforcement of cortical awareness of muscle groups
Hypertrophy of existing muscle fibres
General increase in muscle tone and strength

Question 22

What medication can be offered for incontinence?

Answer 22

Duloxetine

Question 23

What surgical management options are available for incontinence?

Answer 23

Culposuspension
Mid-urethral slings
Retro-pubic tension free vaginal tape (TVT)

Question 24

What are the symptoms of overactive bladder syndrome?

Answer 24

Urgency
Nocturia
Urge incontinence
Frequency

Question 25

What are the risk factors for urge incontinence?

Answer 25

Advanced age
Diabetes
UTIs
Smoking

Question 26

What is the management for overactive bladder syndrome?

Answer 26

Normalise fluid intake 
Reduce caffeine, fizzy drinks, chocolate 
Stop smoking 
Weight loss 
Bladder retraining

Question 27

What pharmacological options can be used to treat overactive bladder syndrome?

Answer 27

Antimuscarinic
Tri cyclic antidepressant
Botox