Incontinence Flashcards
What is the normal range of daytime voids?
4 - 7
Up to what age is more than 1 night-time void considered to be abnormal?
70 years
What is the most common cause of a neurogenic bladder in women?
MS
If the bladder is still palpable after voiding, what type of incontinence is this suggestive of?
Overflow
What is the most common cause of overflow incontinence in males?
Prostatic enlargement
In all patients with incontinence, a frequency/volume chart should be filled out for at least how long?
3 days
Other than a bladder diary, what other investigations should be performed on all patients presenting with incontinence and why?
Urinalysis and MC&S to rule out a UTI
Imaging is not routinely used in the investigation of incontinence; however, if it is required, what would be first line?
Ultrasound
What investigation should be utilised in individuals with incontinence who have recurrent UTIs, haematuria, suprapubic pain or a suspected fistula or tumour?
Cystoscopy
In stress incontinence, leakage from an incompetent urethral sphincter generally occurs when?
When there is increased intra-abdominal pressure
The loss of small (but often frequent) amounts of urine when coughing, laughing etc is most suggestive of which type of incontinence?
Stress incontinence
If the underlying cause of incontinence is a prolapse, what may be a useful treatment?
Pessary
A frequency/volume chart which identifies normal urinary frequency and normal functional bladder capacity is most suggestive of which type of incontinence?
Stress incontinence
When are urodynamic studies used in the investigation of stress incontinence?
Only when surgery is being considered as a treatment
Other than lifestyle advice, what is the first line treatment for stress incontinence?
Pelvic floor exercises
What is the routine of pelvic floor exercises advised by NICE for the treatment of stress incontinence?
8 contractions, 3 times daily for at least 3 months
If pelvic floor exercises and lifestyle advice fail as treatments for stress incontinence, what is the next line management option?
Surgical intervention e.g. mid-urethral tape procedures, injection of bulking agents
What is the only pharmacological agent licensed for treating stress incontinence, but is rarely used?
Duloxetine
Urge incontinence commonly exists alongside what other two symptoms, grouped together to form overactive bladder syndrome?
Frequency and nocturia
What is the cause of urge incontinence and overactive bladder syndrome?
Detrusor muscle hyper-activity
A frequency/volume chart showing increased diurnal frequency and nocturia is most suggestive of which type of incontinence?
Overactive bladder syndrome
When should urodynamic studies be performed in the investigation of urge incontinence/overactive bladder syndrome?
If there is doubt of the diagnosis, complex symptoms or medical treatment has failed
Other than lifestyle advice, what is the first line management option for overactive bladder syndrome/urge incontinence?
Bladder retraining
How long should bladder retraining be done for as a first line treatment for overactive bladder syndrome/urge incontinence?
6 weeks
What group of drugs are used first line in the treatment of urge incontinence?
Anti-muscarinics
How do anti-muscarinic drugs work in the treatment of overactive bladder syndrome/urge incontinence?
Block parasympathetic nerves and relax the detrusor muscle
What is the most commonly used anti-muscarinic drug used in the treatment of overactive bladder syndrome/urge incontinence?
Oxybutynin
Mirabegron is a 2nd line pharmacological agent used in the treatment of overactive bladder syndrome/urge incontinence- what is the mechanism of action of this drug?
Beta 3 agonist
When should mirabegron be used over anti-muscarinic drugs in the treatment of overactive bladder syndrome/urge incontinence?
If you are worried about anti-cholinergic side effects in a frail, elderly person
What may be a useful treatment in women with incontinence due to vaginal atrophy?
Oestrogen creams or pessaries
What is the most common type of urinary incontinence?
Stress incontinence
Continuous dribbling incontinence is suggestive of what diagnosis? What investigation can be used to confirm this diagnosis?
Vesicovaginal fistula - urinary dye studies
