incontinence

Question 1

what is stress incontinence?

Answer 1

when the intra-abdominal pressure exceeds the urethral pressure, such as coughing, straining, laughing, or lifting.

often due to weakness of the pelvic floor muscle.
common post partum

Question 2

what is urge incontinence?

Answer 2

overactive bladder (detrusor hyperactivity) = uninhibited bladder contraction = rise in intravesical pressure and subsequent leakage of urine.

may be due to neurogenic causes (such as a previous stroke), infection, malignancy, or idiopathic.

Medication, e.g cholinesterase inhibitors, can also result in urge UI.

Question 3

what is mixed UI?

Answer 3

urge + stress combined

Question 4

what is overflow UI?

Answer 4

Overflow UI is normally a complication of chronic urinary retention (whereby the progressive stretching of the bladder wall leads to damage to the efferent fibres of the sacral reflex and loss of bladder sensation)

As the bladder fills with urine, it becomes grossly distended however intravesicular pressure builds, leading to a constant dribbling of urine.

The most common cause is from prostatic hyperplasia, however other causes include spinal cord injury or congenital defects.

Question 5

what is continuous UI?

Answer 5

constant leakage of urine, meaning the patient is wet all the time.

due to anatomical abnormality (such as ectopic ureter) or bladder fistulae (e.g. vesicovaginal fistula), however may also be due to severe overflow incontinence.

Question 6

Investigations for UI?

Answer 6

urine dip

post void bladder scan

Question 7

treatment?

Answer 7

conservative
- pelvic floor muscle exercises

surgery

• some injections e.g botulinum toxin A injections for urge
• tension free vaginal tape for stress