Incontinence

Question 1

describe the management of stress incontinence.

Answer 1

1st line: pelvic floor muscle exercises
2nd line: duloxetine
2nd/3rd line: surgery

duloxetine can be given if the patient wishes to avoid surgery. surgery can be 2nd line due to side effects of duloxetine.

Question 2

side effects of duloxetine ?

Answer 2

dry mouth
nausea
fatigue
constipation

Question 3

surgical management options for stress incontinence ?

Answer 3

Burch culposuspension
tension free vagina tape
autologous rectal fascial sling
bladder neck bulking

Question 4

investigations for suspected stress incontinence ?

Answer 4

empty supine stress test
cough stress test

urinalysis (rule out UTI)
urodynamic studies (helpful if type of incontinence is unclear)
post void residual volume (rule out overflow incontinence)

Question 5

sympathetic, parasympathetic and somatic nerve supply of the bladder ?

Answer 5

sympathetic - T10 - L2
parasympathetic - S2-S4
somatic - S2 - S4 pudendal nerve

Question 6

risk factors for urge incontinence ?

Answer 6

smoking 
age 
diabetes 
caffeine 
trauma to nerve innervation

Question 7

causes of overflow incontinence ?

Answer 7

BPH
prolonged catheterisation
no awareness of bladder filling due to MS, stroke

Question 8

describe the management of urge incontinence ?

Answer 8

1st line: lifestyle modifications i.e. smoking cessation, avoid caffeine

2nd line: antimuscarinic i.e. Oxybutynin
other option: selective beta-2 agonist i.e. Mirabegron

3rd line:

• vagifem pessaries
• botulinum toxin
• neuromodulation

Question 9

why should oxybutynin be avoided in the elderly ?

Answer 9

due to increased risk of falls

Question 10

1st line medication in urge incontinence in elderly ?

Answer 10

selective beta-2 agonist- Mirabegron