S7) Urinary Incontinence

Question 1

What is urinary incontinence?

Answer 1

Urinary incontinence is the unintentional passing of urine due to loss of bladder control

Question 2

There are 4 types of urinary incontinence.

Identify them

Answer 2

• Stress Urinary Incontinence
• Urge Urinary incontinence
• Mixed Urinary Incontinence
• Overflow Incontinence

Question 3

What is stress urinary incontinence?

Answer 3

Stress Urinary Incontinence is the involuntary leakage of urine on effort, exertion, sneezing or coughing

Question 4

What is urge urinary incontinence?

Answer 4

Urge Urinary incontinence is the involuntary leakage of urine accompanied by urgency

Question 5

What is mixed urinary incontinence?

Answer 5

Mixed Urinary Incontinence is the involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing

Question 6

What is overflow incontinence?

Answer 6

Overflow incontinence is the involuntary leakage of urine from an overfull bladder, often in the absence of any urge to urinate

Question 7

Have an understanding of the prevalence of urinary incontinence with age

Answer 7

Question 8

Describe the incidence of the different types of urinary incontinence

Answer 8

Question 9

Identify 6 risk factors for urinary incontinence

Answer 9

• Obesity
• Age
• Gender (more common in females)
• Smoking
• Family history
• Neurological disease/diabetes

Question 10

Identify and describe 4 causes of urinary incontinence in females

Answer 10

• Pregnancy – due to hormonal changes and uterine expansion
• Childbirth – weakens muscles needed for bladder control and damages bladder nerves and supportive tissue
• Hysterectomy – due to possible damage of the supporting pelvic floor
• Menopause – due to loss of oestrogen which causes urethra and bladder to deteriorate

Question 11

Identify and describe 4 causes of urinary incontinence in males

Answer 11

• Prostate cancer – often incontinence occurs as a side effect of treatments
• Enlarged prostate gland – benign prostatic hyperplasia (more common in older men)
• Prostatectomy – often surgery damages urinary structures
• Prostatitis – prostate swells and compresses urethra

Question 12

State 4 initial investigations for urinary incontinence

Answer 12

• Urine dipstick (UTI, haematuria, proteinuria, glucosuria)
• Non-invasive urodynamics (frequency-volume chart)
• Invasive urodynamics (pressure-flow studies)
• Cystoscopy

Question 13

In the conservative management of urinary incontinence, identify 5 general lifestyle interventions

Answer 13

• Modify fluid intake
• Weight loss
• Stop smoking
• Decrease caffeine intake (UUI)
• Avoid constipation

Question 14

Identify 3 forms of management for patients with urinary incontinence who are unsuitable for surgery / failed conservative management

Answer 14

• Catheter (suprapubic/urethral)
• Sheath device
• Incontinence Pads

Question 15

What is the initial management for SUI?

Answer 15

Pelvic floor muscle training – 8 contractions x3/day, at least 3 months duration

Question 16

What is the pharmacological management for SUI?

Answer 16

Duloxetine – combined noradrenaline and serotonin uptake inhibitor increases activity in the striated sphincter during continence phase

Question 17

Identify 2 types of surgical management for males with SUI?

Answer 17

• Artificial urinary sphincter
• Male sling procedure

Question 18

Identify 2 types of surgical management for females with SUI

Answer 18

• Low-tension vaginal tapes (permanent)
• Intramuscular bulking agents (temporary)

Question 19

What is the initial management for UUI?

Answer 19

Bladder training – scheduled voiding for at least 6 months duration

Question 20

Identify and describe 2 types of pharmacological management of urinary incontinence

Answer 20

• β3-adrenoceptor agonist increases bladder’s capacity to store urine
• Anticholinergics act on muscarinic receptors to promote urine retention

Question 21

Identify 4 types of surgical management for UUI

Answer 21

• Sacral nerve neuromodulation
• Autoaugmentation
• Augmentation cystoplasty
• Urinary diversion