Urinary Incontinence

Question 1

Who is most affected by urinary incontinence?

Answer 1

Elderly women

Question 2

What are some of the main RF of urinary incontinence?

Answer 2

Increasing age
Previous pregnancy and childbirth
High BMI

Question 3

What are the different types of urinary incontinence?

Answer 3

Urge incontinence 
Stress incontinence 
Functional incontinence 
Overflow incontinence 
Mixed incontinence

Question 4

What is urge incontinence?

Answer 4

Sudden and involuntary loss of urine

Associated with urgency

Question 5

What is urge incontinence due to?

Answer 5

Detrusor overactivity

Question 6

What are the main RF for urge incontinence?

Answer 6

Recurrent UTI
High BMI
Advancing age
Caffine

Question 7

What is stress incontinence?

Answer 7

Leaking of urine when the intra-abdominal pressure is raised putting pressure on the bladder

Question 8

What can increase increase intra-abdominal pressure?

Answer 8

Coughing
Laughing
Sneezing
Exercising

Question 9

What are the main RF for stress incontinence?

Answer 9

Childbirth

Hysterectomy

Question 10

What is functional incontinence?

Answer 10

Having the urge to pass urine but unable to do so

Question 11

What is functional incontinence associated with?

Answer 11

Dementia
Alcohol
Sedating medication

Question 12

What does mixed incontinence include?

Answer 12

Urge and stress incontinence

Question 13

What is overflow incontinence?

Answer 13

When small amounts of urine leak out without warning

Due to pressure on the bladder overcoming the pressure of the outlet structures

Question 14

What are the causes of overflow incontinence?

Answer 14

Underactivity of the detrusor muscle as a result of neurological damage
Constipation
Prostatism as the urinary outlet pressures are too high

Question 15

What are the main investigations for urinary incontinence?

Answer 15

Bladder diaries
Vaginal examination
Urinalysis
Cytometry

Question 16

How long should a bladder diary be kept?

Answer 16

For a minimum of 3 days

Question 17

Why would you carry out a vaginal examination?

Answer 17

To exclude pelvic organ prolapse

To see if they have the ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)

Question 18

Why would you do a urinalysis?

Answer 18

To rule out infection

Question 19

Why would you carry out Cytometry?

Answer 19

To measure bladder pressure whilst voiding

Question 20

What is the management of urinary incontinence dependent on?

Answer 20

Whether stress or urge incontinence is more common

Question 21

What are the 2 forms of management of urge incontinence?

Answer 21

Bladder retraining

Bladder stabilising drugs

Question 22

What are some examples of bladder stabilising drugs?

Answer 22

Oxybutynin
Tolterodine
Darifenacin
Mirabegron

Question 23

Who would you avoid using oxybutynin with?

Answer 23

Frail older women

Question 24

When would Mirabegron be useful?

Answer 24

If there was if concern about anticholinergic side-effects in elderly

Question 25

What are the 3 different managements of stress incontinence?

Answer 25

Pelvic floor muscle training (3 months)
Surgical procedures
Duloxetine

Question 26

What surgical options are there for stress incontinence?

Answer 26

Retropubic mid-urethral tape procedures

Question 27

When would you give Duloxetine for stress incontinence?

Answer 27

When surgery is declined

Question 28

What type of drug is

Answer 28

It is a combined noradrenaline and serotonin reuptake inhibitor