Incontinence

Question 1

define incontinence

Answer 1

involuntary leakage of urine

Question 2

two phases in the micturition cycle

Answer 2

filling phase

voiding phase

Question 3

classification of incontinence

Answer 3

1. overflow
2. urge
3. stress
4. mixed
5. functional

Question 4

define overflow incontinence

Answer 4

bladder obstruction leads to chronic retention

Question 5

presentation of overflow incontinence

Answer 5

hugely palpable bladder
wet at night
renal impairment
constipation?

Question 6

what is urge incontinence?

Answer 6

bladder over-activity which results in need to micturate with or immediately preceded by urgency

Question 7

what is stress incontinence?

Answer 7

incontinence that occurs when exertion e.g. coughing or sneezing

Question 8

causes of stress incontinence

Answer 8

damage to pelvic floor or urethral function (childbirth)

Question 9

causes of OAB

Answer 9

afferent stimulation
excess central facilitation (stress)
paraplegic (loss of central inhibition due to spinal cord injury)
destruction of S2-3
pelvic fracture/ surgery (parasympathetic nerve damage)
idiopathic

Question 10

two causes of loss of urine via the extra-urethral route

Answer 10

1. ectopic ureter (attached to urethra)

2. fistula (vesico-vaginal)

Question 11

presentation of overflow incontinence

Answer 11

hugely palpable bladder

constipation?
obstruction signs- BPH?

Question 12

presentation of incontinence

Answer 12

frequency
urgency
nocturia
hesitancy
dribbling

depends on type

Question 13

diagnosis of incontinence

Answer 13

assess renal function, flow rate, urinalysis, pad testing
bladder diary for 3 days
FVC
cystomethogram to assess urodynamics

Question 14

management of overflow incontinence

Answer 14

catheter
alpha blockers for prostate
rehabilitate bladder

Question 15

management of urge incontinence

Answer 15

diet (avoid caffeine)
retraining
antimuscarinics
beta-3 adrenergics
botulin toxin injection
neuromodulation (pacemaker for the bladder)
enterocystoplasty

Question 16

antimuscarinic options

Answer 16

tolterodine

oxybutynin

Question 17

example of a beta-3 adrenergic

Answer 17

mirabegron

risks hypertension (check BP before use)

Question 18

what does a botox injection do?

Answer 18

paralyses detrusor muscle

Question 19

management of stress incontience

Answer 19

weight loss
smoking cessation
pelvic floor exercises
5-HT/NE uptake inhibitors
tape