Incontinence

Question 1

Outline the possible storage symptoms of urinary incontinence

Answer 1

Frequency

Urgency

Nocturia

Incontinence

Question 2

Outline the possible voiding symptoms of urinary incontinence

Answer 2

Slow stream

Spitting/spraying

Intermittency

Hesitancy

Straining

Terminal dribble

Question 3

Outline the possible post-micturition symptoms of urinary incontinence

Answer 3

Post-micturition dribble

Feeling of incomplete emptying

Question 4

Outline overflow incontinence

Answer 4

Involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate

Neural lesion = between S2-S4

Question 5

Outline the predisposing risk factors relating to urinary incontinence

Answer 5

Co-morbidities

Obesity

Age

Increased intra-abdo pressure

UTI

Drugs

Menopause

Question 6

Briefly outline the investigations used to aid diagnosis of urinary incontinence

Answer 6

Urine dipstick/MSU = UTI, haematuria, proteinuria, glucosuria

Frequency-volume chart

Bladder diary

Post-void bladder scan – in pts with voiding dysfunction

Pressure-flow studies +/- video

Pad tests

Cystoscopy

Question 7

What lifestyle modifications can take take to help address urinary incontinence?

Answer 7

Modify fluid intake

Weight loss

Stop smoking

Decrease caffeine intake

Avoid constipation

Timed voiding

Question 8

Outline treatment options for pts unsuitable for surgery and who have failed conservative management

Answer 8

Indwelling catheter = indwelling, suprapubic

Sheath device = adhesive condom attached to catheter tubing and bag

Incontinence pads

Question 9

What is the initial management for stress urinary incontinence?

Answer 9

Pelvic floor muscle training

Question 10

What are the male and female surgery options for stress urinary incontinence?

Answer 10

Females = low tension vaginal tapes, intramural bulking agents

Males = artificial urinary sphincter, male sling procedure

Question 11

How is urge urinary incontinence initially managed?

Answer 11

Bladder training = schedule of voiding

Question 12

What is the pharmacological management for urge urinary incontinence?

Answer 12

1st Anticholinergics = act on muscarinic receptors M2 and M3 (oxybutynin, tolteridone)

2nd Beta-3 adrenoceptor agonist = increases bladders capacity to store urine (mirabegron)

Vaginal oestrogen = vaginal atrophy

Question 13

What are the surgical options when treating urge urinary incontinence?

Answer 13

Sacral N neuromodulation

Autoaugmentation

Urinary diversion

Question 14

What questions are important during an incontinence Hx?

Answer 14

• storage symptoms
• voiding symptoms
• pain, dysuria, haematuria
• childhood symptoms
• bowel function/frequency
• PMH
• surgery
• Obs+Gynae Hx
• Med review

Question 15

What factors are important during an incontinence exam?

Answer 15

CVS = signs of chronic disease

Cognition = AMT

Neuro = gait, dorsiflexion of toes (S3), perineal sensation (L1-L2), sensation of the sole (S1), sensation of posterior thigh (S3)

Abdo = masses, enlarged kidneys, distended bladder

DRE = anal tone, constipation, rectal mass, prostate

Pelvis = vaginal atrophy, prolapse

Question 16

What are the reversible causes/contributing factors to urinary incontinence?

Answer 16

Fluid intake
UTI
Function - poor mobility, visual impairment, poor dexterity, risk of falls
Medication
Smoking 
Atrophic vaginitis
DM
Chronic constipation