Incontinence

Question 1

Give three types of incontinence

Answer 1

Stress incontinence
Urge incontinence
Overflow incontinence

Question 2

What causes stress incontinence?

Answer 2

Weakness of the bladder outlet:

• external sphincter
• pelvic floor muscles

Question 3

What causes urge incontinence?

Answer 3

Detrusor muscle instability, ie. overactive bladder

• UMS lesion
• detrusor muscle disorder

Question 4

What symptoms (besides urgency) are associated with urge incontinence?

Answer 4

Frequency (but low volume)

Nocturnal incontinence

Question 5

What causes overflow incontinence?

Answer 5

Urinary tract obstruction

• prostatic hypertrophy
• prostate tumour

Question 6

What symptoms are associated with overflow incontinence?

Answer 6

hesitancy
reduced stream
post-micturition dribbling

Question 7

Describe some general treatment strategies for incontinence

Answer 7

Weight loss (decrease intra-abdominal pressure)
Reduce bladder irritants
 - caffeine
 - fruit juice
 - alcohol
Fluid control
 - volume
 - type e.g. reduce caffeine

Question 8

What is the main treatment for stress incontinence?

Answer 8

Pelvic floor exercises

Question 9

What treatment options are available for urge incontinence?

Answer 9

Bladder retraining
Anticholinergics e.g. oxybutynin
Botulinum toxin
Mirabegron

Question 10

What treatment options are available for overflow incontinence?

Answer 10

Treatments for prostatic hypertrophy:
- alpha blockers e.g. tamsulasin, dexazocin
- finasteride
Catheter (last resort)