General

Question 1

Stress incontinence

Answer 1

Incontinence in women, triggered by strenous activity
die to increase in abdominal pressure
- Leakage due to incompetent sphincter

Associated with pelvic floor weakness

Question 2

Urge incontinence

Answer 2

Involuntary leakage accompanied by or immediately preceeded by urgency

May have precipitant

• Arriving home
• Running water
• Coffee

Question 3

Urge incontinence treatment

Answer 3

Bladder training, lifestyle changes

Anti-muscarinics

• Oxybutynin
• Tolterodine

Question 4

Risk factors for stress incontinence

Answer 4

Increasing parity

Vaginal delivery

Episiotomy
- Surgical cut in vagina during delivery

Overweight

Question 5

Micturition physiology

Answer 5

Pudendal nerve= external urethral sphincter contraction

Hypogastric (sympathetic) nerve= internal sphincter contraction
- Releases Ach which binds to muscarinic receptors (M2, M3)

Voiding= urethral contraction and bladder relaxation

Inhibition of voiding= Pontine storage centre

• Sympathetic branches release NA
• Binds to beta-receptors on bladder, alpha receptors on bladder + urethrra
• NA= inhibits bladder contraction and urethral contraction

Question 6

Urge incontinence physiology

Answer 6

Caused by disruption in the co-ordination of micturition.

Question 7

Overactive bladder

Answer 7

Urgency with or without urge incontinence
- Due to detrusor overactivity

Usually accompanied by

• Urinary frequency
• Nocturia

Question 8

Mixed incotinence

Answer 8

Combination of stress and urge incontinence

Question 9

Overflow incontinence

Answer 9

Urinary leakage from and over-distended bladder

Question 10

Investigations of incontinence (women)

Answer 10

Empty supine stress test

• Valsalva manoeuvre + dorsal lithotomy position
• Leakage= positive

Urinalysis

• Underlying infection
• May indicate malignancy

Post-void residual measurement

• Elevated if >100mL or >50% of voided volume
• May show urinary retention if overflow incontinence

Cough stress test

• Bladder filled with sterile 300mL fluid
• Valsalva in dorsal lithotomy position
• Leakage= positive

Question 11

Stress incontinence managemanet

Answer 11

Behavioural + lifestyle

• Pelvic muscle exercises
• Weight loss, caffeine reduction, fluid management, smoking cessation

Pharmacotherapy

• Pseudoephedrine
• Imipramine

Surgery

• Colposuspension
• Autologous rectus fascial sling
• Retropubic mid-urethral mesh sling