GU, GI: Urinary, Fecal Incontinence

Question 1

Urinary incontinence

• risk factors
• types and presentation

Answer 1

Risk factors

• age
• pregnancy, childbirth
• obesity
• hysterectomy
• FHx

Urge - detrusor overactivitiy
Stress - leaks when abdo pressure increases
Mixed - urge and stress
Overflow - BPH blocks outflow

Question 2

Urinary incontinence

• investigations, diagnosis
• management for stress, urge

Answer 2

Clinical diagnosis

• bladder diary
• vaginal examination - pelvic organ prolapse?
• urine dipstick, urodynamic studies

Urge management - bladder retraining

• Anticholinergic - oxybutynin/tolterodine
• B3ag if anticholinergic not suitable - mirabegron

Stress management - pelvic floor
-Surgery

Question 3

Fecal incontinence

• risk factors
• presentation
• management

Answer 3

Neuro - diabetes, stroke
Neuromuscular - childbirth, abdo surgery

Sudden urges, may leak
Frequent episodes

Management

• avoid foods that worsen incontinence
• pelvic floor exercise
• bulking agents
• surgery if needed

Question 4

Constipation

• risk factors
• presentation
• management

Answer 4

PD
Opioids, anticholinergics

Decreased frequency
Abdo mass, pain if severe
Anorexia, fatigue

Management

• lifestyle, dietary changes
• laxatives, suppositories, enemas

Question 5

Side effects of anticholinergics

Answer 5

ABCDs

• Agitation
• Blurry vision
• Constipation, confusion
• Dry mouth
• Sedation, stasis of urine, sweating