Incontinence

Question 1

what are the extrinsic factors that can cause incontinence in the elderly?

Answer 1

physical state and co-morbidities
drinking too much 
confusion (delirium, dementia)
reduced mobility
medications e.g. diuretics
constipation
home circumstances
social circumstances

Question 2

what are the treatments for stress incontinence?

Answer 2

pelvic floor muscle training/exercises
oestrogen cream
duloxetine
TVT / culposuspension

Question 3

what are the treatments for overflow incontinence?

Answer 3

alpha blocker, anti-androgen (decrease prostate)

TURP

Question 4

what are the treatments for urge incontinence?

Answer 4

anti muscarinic
tricyclic antidepressant
botulinum
neuromodulation

Question 5

what are the indications for referral if someone has incontinence?

Answer 5

failure of initial management for over 3 months
gynaecological condition 
palpable bladder after micturating 
high residual volume after micturating 
BPH 
previous surgery for incontinence 
disease of the CNS

Question 6

what is neuropathic bladder?

Answer 6

reduced/absent awareness of bladder filling resulting in overflow incontinence

Question 7

what are the causes of a neuropathic bladdeR?

Answer 7

stroke
MS
secondary to prolonged catheterisation

Question 8

what is the treatment for neurogenic bladder?

Answer 8

catheterisation

can try parasympathomimetics

Question 9

if a patient is incontinent but after investigations there is nothing pathologically wrong, what are the management options?

Answer 9

incontinence pads 
urosheaths
intermittent catheterisation
long term cathetersation
suprapubic catheter

Question 10

what is the typical presentation of stress incontinence?

Answer 10

women with children
weak pelvic floor muscles
cough or sneeze causing incontinence

Question 11

what is the most common cause of overflow incontinence?

Answer 11

BPH

Question 12

what initial investigations would you carry out for urinary incontinence?

Answer 12

urinalysis
post-voiding residual measurement
cough stress test
urodynamics

Question 13

when would you refer a patient with faecal incontinence?

Answer 13

after failure of initial management

• suspect sphincter damage or neurological disease

Question 14

what is the parasympathetic supply of the bladder?

Answer 14

S2-S4 via pelvic plexus

Question 15

what is the sympathetic supply of the bladder?

Answer 15

T10-L2 via hypogastric plexus

Question 16

what is the nerve supply of the external urethral sphincter?

Answer 16

pudendal nerve (S2-S3)