Incontinence

Question 1

Urge incontinence

Answer 1

Typically managed by combining drug therapy with pelvic floor exercises/bladder training.

Question 2

Drug treatment

Answer 2

1st line = antimuscarinic drugs
2nd line = beta-3 agonist

Question 3

Antimuscarinic - MoA

Answer 3

Relax urinary smooth muscle.
Reduce symptoms of urgency and urge incontinence.
Increases bladder capacity

Question 4

Antimuscarinic - examples

Answer 4

• Oxybutynin
• Tolterodine

Newer antimuscarinics:
- Solifenacin
- Darifenacin
- Trospium

Question 5

Beta-3 agonist - examples

Answer 5

Mirabegron - relaxes urinary smooth muscle via selective b3 receptor stimulation.

Question 6

Antimuscarinic - Side effects

Answer 6

• Constipation
• Dry mouth
• Sweating
• Dilated pupils
• Dry skin
• Photophobia
• Skin flushing

Question 7

Antimuscarinics + driving

Answer 7

Affect performance of skilled tasks e.g. driving

Question 8

Stress incontinence

Answer 8

1st line = pelvic floor muscle training

Duloxetine given second line to women who prefer drug treatment to surgery/do not meet criteria for surgery.

Question 9

Duloxetine

Answer 9

Moderate-severe stress incontinence in women only.
Avoid abrupt withdrawal.