Urinary incontinence

Question 1

what parts of the brain control continence

Answer 1

postcentral gyrus senses fullness
initiation of micturition is managed by precentral gyrsu
voluntary micturition is frontal cortex

Question 2

what levels of spinal cord and divisions manage continence

Answer 2

bladder distention activates T11-L2 SNS which keeps detrusor relaxed
S2-4 PNS contracts detrusor and internal sphincter

Question 3

what changes in age may lead to incontinence

Answer 3

decreased bladder capacity and urethral closure pressure

increased post void residual and detrusor overactivity

Question 4

transient cause incontinence

Answer 4

delirium
infeciton
atrophic urethritis/vaginitis 
pharmaceutical/prostate 
psychological
endocrine/excess fluid 
restricted mobility 
stool impaction

Question 5

what is stress incontinence

Answer 5

involuntary leak on effort or exertion, sneeze, cough

Question 6

what is urge incontinence

Answer 6

involuntary leak immediately preceded by urgency

Question 7

what is mixed incontinence

Answer 7

involuntary leak associated with urgency and exertion, effort, sneeze, cough

Question 8

what is functional incontinence

Answer 8

unable to reach or use toilet over time
poor mobility
cognitive impairment

Question 9

what is overflow incontinence

Answer 9

bladder leak owing to bladder outflow obstruction causing post void residual

Question 10

urinary storage symptoms?

Answer 10

frequency
nocturia
urgency

Question 11

urinary voiding symptoms?

Answer 11

dribbling
poor stream
hesitancy

Question 12

drugs that may cause urine incontinence

Answer 12

sedatives
hypnotics
antimuscarinics
alcohol

Question 13

examinations to carry out in pt with incontinence?

Answer 13

general and BMI
mobility and cognitive 
abdo 
pelvic 
PR 
urinalysis

Question 14

when would you carry out urinalysis in a patient with incontinence

Answer 14

if something suspected and the result would change your management

Question 15

investigations for urinary incontinence

Answer 15

bladder diary
post void bladder scan
blood glucose, PSA, U&E
urodynamic studies

Question 16

lifestyle management of incontinence

Answer 16

reduce caffeine
lose weight
bowel movements and address

Question 17

physical/behavioural management of incontinence

Answer 17

stress- pelvic floor exercise
urge/mix - bladder train
exercise
prompted and times void training

Question 18

pharmacological management of incontinence?

Answer 18

3m non-pharm mx
tolterodine first line
solifenacin 2nd line or first line CI
3rd line is to stop antimuscvarinic and mirabegron

Question 19

when would you review/stop medication for incontinence

Answer 19

4-6 weeks and not working

Question 20

side effect of mirabegron?

Answer 20

hypertension so monitor BP

Question 21

possible management options for nocturia

Answer 21

late afternoon loop diuretic

desmopressin

Question 22

contraindications to desmopressin

Answer 22

low Na after 3 days

>65 with HTN or heart disease

Question 23

true/false - intravaginal oestrogens are beneficial in incontinence

Answer 23

true

Question 24

management options for significant post void residual

Answer 24

treat constipation

men - alpha blockers or 5-alpha reductase inhibitors

Question 25

when to consider specialty referral for incontinence

Answer 25

symptomatic prolapse at or below introitus 
microscopic haematuria >50
frank haematuria 
recurring/persisting UTI
suspected masses
chronic retention 
men with stress UI
failing conservative mx

Question 26

when are long term catheters indicated

Answer 26

patient or carer cannopt self catheterise
medical mx failed and surgical inappropriate
patient distressed by changing linen/clothing
patient has skin wound/pressure ulcers contaminated by urine