Incontinence

Question 1

Mirabegron

Answer 1

drug for urge incontinence stimulate sympathetic

Question 2

Local innervation

Answer 2

S2-S4: Parasympa, increases strength and frequency of contraction
T10-L2: Sympa, B adrenoreceptor causes detrusor to relax
a adrenoceptor causes contraction of neck of bladder and internal urethral sphincter
S2-S4: Somatic, contrraction of Pelvic floor muscle and external sphincter

Question 3

CNS connections

Answer 3

centers in CNS promote urine storage
sphinter closure mediated by relfex increase in a adrenergic and somatic activity.
pontine micturition normally exerts neutral connections until voluntary switch to voiding occurs

Question 4

Bladder outlet too weak

Answer 4

common in women with children after menopause
treatment physio, oestrogen cream
surgical- TVT/ colposuspension
kegel exercisers

Question 5

urinary retention with overflow incontinence

Answer 5

poor urine flow, double voiding, hesitancy, post micturition dribbling,
older men with BPH
treat with alpha blocker, anti androgen or surgical
may need catheterisation- supra pubic

Question 6

Urge incontinence

Answer 6

detrusor contracts at low volumes,
can be caused by bladder stones
treat with anti muscarinics (relax detrusor)
bladder retraining

Question 7

Main drugs used

Answer 7

antimuscarinics
Beta 3 adrenoceptor agonists
Alpha blockers
Anti androgen drugs

Question 8

Neuropathic bladder

Answer 8

secondary to neurological disease, prolonged catheterisation
no awareness resulting in overflow
parasympathomimetics might help
only treatment catheter

Question 9

scheme for assessing incontinence

Answer 9

careful history- social, impact of incontinence, extrinsic factors
intake chart and urine output diaries
GE rectal and vaginal
Urinalysis and mild stream specimen urine
bladder scan for residual volume
lifestyle and behavioural changes
physio, medical treatment

Question 10

referral to specialists

Answer 10

after failure of initial management (max 3 months of pelvic floor exercises, cone therapy
vesico vaginal fistula
palpable bladder after micturition
disease of CNS
Severe BPH or prostatic carcinoma
previous surgery due to incontinence
faecal incontinence

Question 11

other options

Answer 11

incontinence pads

intermittent catheterisation