Incontinence

Question 1

Risk factors for urinary incontinence

Answer 1

• advancing age
• previous pregnancy and childbirth
• high body mass index
• hysterectomy
• family history

Question 2

What is overactive bladder (OAB)/urge incontinence

Answer 2

due to detruser over-activity

Not quite making it to the bathroom

Question 3

What is stress incontinence

Answer 3

leaking small amounts when coughing or laughing

Question 4

What is mixed incontinence

Answer 4

Both urge and stress incontinence

Question 5

What is overflow incontinence

Answer 5

due to bladder outlet obstruction, e.g. due to prostate enlargement

Question 6

What are the initial investigations for incontinence

Answer 6

• bladder diaries min 3 days
• vaginal examination: prolapse/ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
• urine dipstick and culture
• urodynamic studies

Question 7

Management of urge incontinence

Answer 7

• bladder retraining

- bladder stabelising drugs

Question 8

Management of stress incontinence

Answer 8

• pelvic floor muscle retraining
• Avoiding caffeine / diuretics / overfilling the bladder
• weight loss
• Duloxetine (serotonin-norepinephrine reuptake inhibitor)
• surgical procedures: e.g. retropubic mid-urethral tape procedures

Question 9

What are bladder stabelising drugs

Answer 9

1. antimuscarinics: oxybutynin, tolterodine or darifenacin

2. Avoid immediate release oxybutynin in frail women

Question 10

What are bladder stabelising drugs

Answer 10

1. antimuscarinics: oxybutynin, tolterodine or darifenacin
2. Avoid immediate release oxybutynin in frail women
3. mirabegron (a beta-3 agonist) for frail women

Question 11

What do NICE recommend RE pelvic floor muscle retraining

Answer 11

8 contractions performed 3 times per day for a minimum of 3 months