Incontinence

Question 1

What is the first-line management for urge incontinence?

Answer 1

Bladder diary and bladder re-training

+ consideration of fluid management, pelvic floor exercise and topical oestrogen

Aka only go to toilet 15 min after urge to go

Question 2

What should be done in people with urge incontinence where bladder re-training was unsucsessful?

Answer 2

After 3 months of conservative: Anticolinergics (relaxation of detrusor muscle)

• Oxybutynin (< 3 year if over 70 because of cognitive decline)

Question 3

What are the side-effects and contraindications to anticholinergics?

Answer 3

Side effects: dry eyes, dry mouth, constipation, nausea

Contraindications: closed- angle glaucoma, myasthenia gravis, paralytic ileus, pyloric stenosis and known prostatic enlargement

Question 4

What medical management can be started in urge incontinence if anticolinergics are contraindicated/ not tolerated?

Answer 4

Mirabegron (contraindication: hypertension)
* sympathomimetic beta-3 adrenergic receptor agonist used to relax the smooth muscle of the bladder –> less effective than anticholinergics
* Preferable side-effect profile

Question 5

What is the first-line treatment for stress incontinence?

Answer 5

Pelvic floor training (50% effective in 3 months)

Question 6

What is the first line medical management for stress incontience?

Answer 6

If pelvic floor exercise ineffective after 3 months: referral to uro-gynae and start of
**Duloxetine **