G18 urinary incontinence

Question 1

What diagnosis are you considering and what other urinary symptoms will you ask about to clarify this?

Answer 1

main diagnosis is urodynamic stress incontinence(most common) due to the laxity of the pelvic floor muscles and the proximal third of urethra falling outside the intraabdominal pressure zone.

ask about other urological symptoms;

• frequency
• urgency
• dysuria
• difficulty voiding
• haematuria,
• urge incontince

Question 2

types of incontinence

Answer 2

1. stress incontinence: urinary incontinence (UI) due to increased intra-abdominal pressure, associated with coughing and exertions
2. urge incontinence: leakage of urine associated with sudden urge to void, freq of micturition (overactive detrusor muscle)
3. mixed: both stress and urge symptoms. common in middle age/ older women with fluctuating estrogen levels
4. functional: inability to reach/use/request on appropriate receptable to void into: environmental, dexterity, moiblity, communication

Question 3

predisposing factors

Answer 3

1. age
2. obesity
3. smoking
4. chronic cough
5. constipation
6. lack of estrogen
7. previous surgery
8. parturition
9. pregnancy

Question 4

examination

Answer 4

1. general wellbeing: BMI
2. abdominal examination
3. pelvic examination
   - speculum; pelvic organ collapse, anterior, middle, posterior using sims speculum
   - check for estronegisation
   - bimanual: rule out pelvic organ pathology (pelvic mass) and check voluntary pelvic floor muscle contraction

Question 5

investigation primary setting

Answer 5

MSU and urinary diary

Question 6

treatment primary setting option

Answer 6

1. local estrogen
2. refer to physiotherapist/continence advisor for trial of pelvic floor muscle training or bladder retraining if there is presence of freq and urgency

medications

• anticholinergic (oxybutynin)
• duloxetine (serotonin and NA inhibitor)
  3. refer to gynae.urondynamic studies
• how well bladder, sphincter and urethra hold and release urine

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