Incontinence

Question 1

What are the risk factors for urinary incontinence?

Answer 1

Advancing age,
Previous pregnancy or childbirth,
High BMI<
Hysterectomy,
Family history

Question 2

What are the different classifications of incontinence?

Answer 2

Overactive bladder/urge incontinence - |Due to detrusor overactivity.
Stress incontinence - Small leaks when laughing or coughing.
Mixed incontinence - due to both urge and stress.
Overflow incontinence - due to bladder outlet obstruction.
Functional incontinence - comorbid physical condition which impairs patient’s ability to get to bathroom in time

Question 3

What are the investigations for urinary incontinence?

Answer 3

1. Bladder diaries for min 3 days.
2. Vaginal exam to exclude prolapse,
3. Urine dip and culture.
4. Urodynamic studies

Question 4

What is the management of urinary incontinence?

Answer 4

Urge - Bladder retraining, antimuscarinic drugs (oxybutynin) or Mirabegron in elderly patients.
Stress - Pelvic floor training. surgical procedure’s, if declined then can used duloxetine.

Question 5

What are some causes of faecal incontinence?

Answer 5

Obstetric trauma,
Risk factors: older age, nursing home residents, history of IBD,
Cauda equina syndromehaemorrhoids,
Patulous anus,
Weak squeeze pressure

Question 6

What are the investigations for fecal incontinence?

Answer 6

Examination +/- endoscopy. May show prolapse, constipation, rectal mass.
Others: Anorectal manometry, anorectal ultrasound (look at sphincter)