types of incontience

Question 1

what is stress incontinence

Answer 1

Stress incontinence happens when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine

cause a leak due to pressure

Question 2

how do we treat stress incotneince first Line non med \

and surgical

Answer 2

pelvic floor exercise for 3 times a day for 3 months

surgical procedures: e.g. retropubic mid-urethral tape procedures

Question 3

what is the pharmacological treatment for stress incontinence

Answer 3

duloxitine SNRI

mechanism of action: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced
contraction

Question 4

what can you not give duloxitien

Answer 4

diuretics

Question 5

what is urge incontinence

Answer 5

urge incontinence – when urine leaks as you feel a sudden, intense urge to pee, or soon afterwards. overflow incontinence (chronic urinary retention) – when you’re unable to fully empty your bladder, which causes frequent leaking.

overactive bladder (OAB)/urge incontinence
due to detrusor overactivity
the urge to urinate is quickly followed by uncontrollable leakage ranging from a few drops to complete bladder emptying

Question 6

what do you treat urge incontinence with non med

Answer 6

bladder retraining (lasts for a minimum of 6 weeks, the idea is to gradually increase the intervals between voiding)

Question 7

medical first line for urge incotneince

1st
2nd
3rd line

Answer 7

bladder stabilising drugs: antimuscarinics are first-line
oxybutynin
tolterodine next

mirabegron (a beta-3 agonist) may be useful if there is concern about anticholinergic side-effects in frail elderly patients

Question 8

avoid oxybutynin in who

Answer 8

old frail women

Question 9

what is overflow incontience

Answer 9

due to bladder outlet obstruction, e.g. due to prostate enlargement
functional incontinence

omorbid physical conditions impair the patient’s ability to get to a bathroom in time
causes include dementia, sedating medication and injury/illness resulting in decreased ambulation

Question 10

what investigations should be done for someone with inconteince

Answer 10

bladder diaries should be completed for a minimum of 3 days

vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)

urine dipstick and culture

urodynamic studies