Incontinence

Question 1

Initial investigations into incontinence?

Answer 1

Bladder diary
MSU dupstick
Vaginal examination - to exclude cystocele

Question 2

Management for stress incontinence?

Answer 2

Pelvic floor exercises - 8 contractions a day for a minimum of 3 months (aim for >6 months)

Duloxetene (not v effective)

Surgery e.g. transvaginal tape

Question 3

Management for urge incontinence?

Answer 3

Cut down caffeine and smoking

Bladder retraining - lasts minimum 6 weeks

Antimuscarinics - oxybutynin (immediate release), tolterodine (intermediate release) or darifenacin (once daily)
NB. avoid oxytbutynin in frail elderly women

Botox before menopause, oestrogen after menopause