Urinary Incontinence

Question 1

What investigations / examinations can be done to investigate urinary incontinence?

Answer 1

Bladder diary
Gynaecological exam
Rectal exam
Cough stress test
Empty supine test
Post-void residual volume
Urinalysis
Urodynamic study
Cystourethroscopy

Question 2

What can cause stress incontinence?

Answer 2

Damage to the pelvic floor muscles via pregnancy, birth, obesity, aging and high-impact activities e.g. weight lifting

In men - post-prostatic surgery

Question 3

What can cause urge incontinence?

Answer 3

BPH
MS
Stroke
PD
Spinal cord injury 
Spina bifida
Diabetes mellitus
Diabetes insipidus
Primary polydipsia
Caffeine
Diuretics

Question 4

What general non-pharmacological management strategies can be used in urinary incontinence?

Answer 4

Weight loss
Decreased caffeine and fluid intake
Pelvic floor muscle exercises
Bladder training

Question 5

Describe the pharmacotherapy management of stress incontinence?

Answer 5

1st line - pseudoephidine
2nd - duloxetine
Adjunct - oestrogen, peri-urethral bulking injection

Question 6

Describe the pharmacotherapy management of urge incontinence?

Answer 6

1st line - anticholinergics (oxybutinin, tolteradine)
2nd line - neuromodulation
3rd line - botulinum A toxin injection

Question 7

What are the potential complications of urinary incontinence?

Answer 7

Skin injections, rashes, sores
Recurrent UTI
Psychosocial - depression, social isolation