Incontinence

Question 1

when are the two peaks when people are most likely to experience incontinence?

Answer 1

• after menopause

- in old age

Question 2

what are the extrinsic causes of incontience?

Answer 2

• reduced mobility
• confusion
• drinking too much @ wrong time
• medications (diuretics)
• constipation
• home and social circumstances

Question 3

what do the drugs for incontinence target?

Answer 3

The autonomic nervous system - wide range of side effects.

Question 4

how is the detrusor muscle supplied?

Answer 4

smooth muscle

Question 5

how is the internal urethral sphincter innervated?

Answer 5

smooth muscle - ANS

Question 6

how is the external urethral sphincter innervated?

Answer 6

skeletal muscle

Question 7

what does the parasympathetic nerves do to the bladder and urethra?

Answer 7

Bladder - contracts it

internal urethral sphincter - relaxes it

Question 8

what does the sympathetic nerves do to the bladder and urethral sphincter?

Answer 8

Relax detrusor muscle

contract internal urethral sphincter

Question 9

how much urine does the bladder usually hold?

Answer 9

400-600mls

Question 10

at what volume do you get an awareness that your bladder is filling?

Answer 10

250mls.

Question 11

how much urine is normal to be left over after voiding?

Answer 11

up to 100mls

anything over 250mls is abnormal

Question 12

what is the normal tone of the bladder?

Answer 12

there is permanent inhibitory tone which goes down to the bladder telling it to relax

Question 13

what happens to CNS and bladder when you lose consciousness?

Answer 13

the permanent inhibition of ladder contraction is lost so bladder contracts causing voiding.

Question 14

which part of the brain are involved in storage of urine?

Answer 14

pons micturition centre
frontal cortex
caudal part of spine

Question 15

what are the 4 intrinsic factors affecting incontinence?

Answer 15

• bladder too strong
• bladder too weak
• outlet too strong
• outlet too weak

Question 16

what is stress incontinence?

Answer 16

when bladder outlet is too weak

- urine leak on movement, coughing, laughing.

Question 17

who commonly gets stress incontinene?

Answer 17

post menopausal women (loss of oestrogen that strengthens muscles)
after giving birth

Question 18

what is the treatment for stress incontinence?

Answer 18

Mainly physiotherapy - Kegel exercise, vaginal cones, pelvic floor stimulators
oestrogen cream
duloxetine
colposuspension

Question 19

what is urinary retention with overflow incontinence?

Answer 19

bladder outlet too strong

• poor urine flow, double voiding, hesitancy, post micturition dribbling.

Question 20

who commonly gets urinary retention with overflow incontinence?

Answer 20

older men - BPH

Question 21

how is urinary retention treated?

Answer 21

alpha blocker - tamsulosin (relieves sphincter)
anti-androgen - finasteride (shrinks prostate)
surgery - TURP

catheterisation - often suprapubic

Exercises don’t tend to work for this sort of incontinence

Question 22

what is urge incontinence?

Answer 22

the bladder muscle is too strong

detrusor muscle contracts when not full, sudden urge immediately, caused by bladder stones or stroke

Question 23

how is urge incontinence treated?

Answer 23

anti muscarinics/cholinergics - target cholinergic receptors and block them to relax detrusor muscle.

oxybitinin
tolterodine
solifenacin

Question 24

what drugs relax the detrusor muscle?

Answer 24

antimuscarinics - oxybutin, tolterodine, solifenacin, trospium

Beta-3 adrenoreceptor agonists - mirabegron

Question 25

which drugs shrink the prostate?

Answer 25

anti-androgens - finasteride, dutasteride

Question 26

which drugs relax the sphincter and bladder neck?

Answer 26

alpha blockers - tamsulosin, terazosin, indoramin

Question 26

which drugs relax the sphincter and bladder neck?

Answer 26

alpha blockers - tamsulosin, terazosin, indoramin

Question 27

what is neuropathic bladder?

Answer 27

underative bladder
secondary to neurological disease - multiple sclerosis and stroke

catheter is most common cause and treatment

RESULTS IN OVERFLOW INCONTINENCE.

Question 28

when should someone be referred to a specialist?

Answer 28

if initial management (3 months of non pharmacological treatment + medication) doesn’t work

Question 29

when is referral to a specialist needed straight away?

Answer 29

vesico-vaginal fistula
palpable bladder after voiding
faecal incontinence

Question 30

what are the last resorts for treatment?

Answer 30

pads
urosheats
intermittent catherisation (better)
catheterisation - worse 
suprapubic catheter