Incontinence

Question 1

What are the types

Answer 1

1. Stress
2. Urge
3. Overflow

Question 2

What are RFs

Answer 2

⎫	Multiparity
⎫	Hysterectomy 
⎫	Obesity
⎫	Prostate surgery 
⎫	Bowel dysfunction 
⎫	Menopause
⎫	Dietary factors - caffeine, alcohol 
⎫	Drugs - TCA’s, diuretics

Question 3

What is stress incontinence?

Answer 3

incompetent sphincter causes leakage of urine

Question 4

what are causes?

Answer 4

obesity
chronic cough, laughing, exercise
Pelvic floor damage - childbirth, trauma, prostatectomy

Question 5

What is rx of stress?

Answer 5

1. Pelvic floor exercises
2. Intravaginal electrical stimulation
3. Ring pessary - cervix sits on a ring
4. Surgery:
   − Sling procedure - sling attached to abdo wall and lifts top part of the urethra, pressure and incontinence
   − Tension free vaginal tape - higher success rate and fewer SE
   − Open colposuspension
5. Duloxetine - SNRI relieves symptoms, SE: N&V, abdo pain

Question 6

What is urge incontinence?

Answer 6

overreactive bladder or detrusor overactivity

Question 7

What are causes of urge incontinence?

Answer 7

• Detrusor instability - result of local irritation of bladder e.g. inflammation, infection
• Brain damage - seen in elderly as result of stroke, Parkinson’s or dementia

Question 8

What is overflow incontinence?

Answer 8

Muscles of bladder can’t squeeze properly to empty the bladder

Question 9

What are causes of overflow incontinence?

Answer 9

− Urethral stricture - such as enlarged prostate, kidney and bladder stones
− Detrusor weakness - may be seen in MS or diabetes (autonomic neuropathy)

Question 10

What is treatment of overflow incontinence?

Answer 10

1. Identify + eliminate the obstruction
2. Consider alpha blockers for prostatic enlargement
3. Catheterisation
4. Anticholinergics worsen sx of this type of incontinence