Female Urinary Incontinence

Question 1

What are the principles of pelvic organ support and how does it lead to incontinence?

Answer 1

Risk factors: age, parity, menopause, smoking, medical, increased intrabdominal pressure, pelvic floor trauma, denerbatiom, connective tissue disease, surgery

Stress and urge Incontinence may arise from the same anatomical defect in the anterior vaginal wall and pubourethral ligament.

Suburethral hammock laxity might result in stimulation of bladder neck stretch receptions provoking premature micturition reflect and urgency incontinence.

Question 2

What are the main types of female urinary incontinence?

Answer 2

Urinary incontinence: any involuntary leakage of urine

Stress UI: involuntary leakage on effort or exertion, sneezing or coughing

Urge UI: involuntary leakage accompanied by or immediately preceded by urgency (risk factors include older age, diabetes, UTIs and smoking)

Mixed UI: involuntary leakage accompanied by or immediately preceded by urgency & on effort or exertion or on sneezing or coughing

Overactive bladder syndrome: urgency +/- urge incontinence, usually with frequency and nocturia

Question 3

How is female urinary incontinence diagnosed, investigated and managed?

Answer 3

Diagnosed via clinical history and investigations.

Investigations include:

• history eg age, parity, medical history; symptoms eg irritation (urgency, frequency, haemat/noct/dysuria), incontinence (stress, urgency, coital, severity), voiding (strain, hesitancy, UTI, flow), prolapse, bowel. Fluid intake. Effect on QoL.
• urinary diary
• urine dipstick
• examination: general, abdominal if mass, neuro if signs, gynae if prolapse, pelvic floor assessment vis oxford scale

Then:

• urinanalysis eg multistix +/- mssu
• post voiding residual volume assessment only if symptoms of voiding difficulties
• urodynamics only if surgery is contemplated

Managed by: lifestyle changes (stop smoking, weight loss, diet and drink advice), medical treatment (duloxetine), physio therapy (pelvic floor training), surgery (culposuspension, tension free vaginal tape)

OAB: treat symptoms via lifestyle interventions, bladder training programme, antimuscarinic medicine, tricyclics antidepressants eg imipramine. Newer advances include Botox and neuromodulation.