Urinary Incontinence

Question 1

What is this describing and why does it happen?

Involuntary leakage of urine on effort, exertion, sneezing or coughing.

Answer 1

1. Stress incontinence

2. Incompetent sphincter

Question 2

What are the risk factors for stress incontinence and who is it common in?

Answer 2

1. Increasing age and obesity

2. Pregnancy and following birth

Question 3

What is this describing and why does it happen?

Involuntary leakage of urine accompanied by or immediately preceded by urgency.

Answer 3

1. Urge incontinence

2. Uncontrollable bladder emptying as detrusor contracts

Question 4

What precipitates urge incontinence?

Answer 4

Arriving home, cold, sound of running water, caffeine, obesity.

Question 5

What are the causes of urge incontinence?

Answer 5

Detrusor overactivity from CNS inhibitory malfunction, UTI, diabetes mellitus, diuretics, atrophic vaginitis.

Question 6

What are the causes of urinary incontinence in men?

Answer 6

1. Enlarged prostate is the main cause

2. Detrusor overactivity, urethral stricture, post-trauma or STI, TURP may weaken bladder sphincter.

Question 7

What is the management for stress incontinence?

Answer 7

1. Pelvic floor exercises and lifestyle changes
2. Duloxetine/pseudoephedrine
3. Topical oestrogen if post-menopausal

Question 8

What is the management for urge incontinence?

Answer 8

1. Pelvic floor exercises and lifestyle changes
2. Anticholinergic medication (tolterodine, oxybutynin)
3. Topical oestrogens
4. B3 adrenergic agonists (mirabegron) if they cannot tolerate anticholinergic side effects.
5. Intravesical botox if above fail.