Incontinence

Question 1

define

Answer 1

this is involuntary leakage of urine

Question 2

phases in the micturition cycle

Answer 2

filling phase

voiding phase

Question 3

three ways urine can be involuntary lost from the urethra

Answer 3

1. overflow
2. urge
3. stress

Question 4

describe overflow incontinence

Answer 4

bladder obstruction leading to chronic retention

Question 5

presentation of overflow incontinence

Answer 5

wet at night

renal impairment

Question 6

presentation of urge incontinence

Answer 6

provocation

involuntary enuresis

Question 7

cause of urge incontinence

Answer 7

bladder over-activity

Question 8

what causes bladder over-activity

Answer 8

afferent overstimulation (source of irritation)
excess central facilitation (stress)
paraplegic (loss of central inhibition due to spinal cord injury)
destruction of S2,3
pelvic surgery/ fracture (parasympathetics damage leaving residual urine which can get infected)
idiopathic (post-pregnancy)

Question 9

describe stress incontinence

Answer 9

damage to pelvic floor or urethral function (childbirth) so occurs when coughing, sneezing, etc.

Question 10

two ways urine can be lost from the extra-urethral route?

Answer 10

ectopic ureter

fistula

Question 11

describe ectopic ureter

Answer 11

ureter attached to urethra

congenital

Question 12

presentation of ectopic ureter

Answer 12

babies always wet

cannot get out of nappies

Question 13

describe fistula

Answer 13

vesico-vaginal fistula so urine falls out of vagina

Question 14

causes of fistula

Answer 14

obstructed labour or surgery

Question 15

presentation of incontinence

Answer 15

hugely palpable bladder

Question 16

diagnosis of incontinence

Answer 16

cystomethogram (assess urodynamics)
assess renal function
frequency volume chart (FVC) for at least 24 hours
bladder diary

Question 17

management of overflow incontinence

Answer 17

treat obstruction
catheter (self teach)
rehabilitate bladder

Question 18

management of urge incontinence

Answer 18

diet (avoid caffeine)
bladder retraining
antimuscarinics (oxybutynin, tolterodine)
beta-3 adrenergics (mirabegron)
botulin toxin injection (paralyses detrusor)
neuromodulation (pacemaker for bladder)
enterocystoplasty

Question 19

management of stress incontinence

Answer 19

weight loss
smoking
pelvic floor exercises (physiotherapy)
serotonin 5-HT
norepinephrine NE reuptake inhibitor
tape procedures