Urinary incontinence

Question 1

What are the types of UI?

Answer 1

Urge, stress, overflow, functional, continuous, mixed (stress and urge)

Question 2

What is urge incontinence?

Answer 2

Urge and frequency of urination

Often due to detrusor overactivity

Question 3

What is stress incontinence?

Answer 3

Prevalent in women (prostate protective fx)
Often due to pelvic floor weakness
Compounded by atrophic vaginitis, due to oestrogen deficiency

Question 4

What is overflow incontinence?

Answer 4

Due to obstruction (i.e. BPH) causing chronic retention

Question 5

What causes continuous incontinence?

Answer 5

Fistulae (risk fx: ca, crohns, surgery)

Question 6

Why is UI often underdiagnosed in the elderly?

Answer 6

Embarrassment
Belief it is a normal part of aging
Not asked by health professionals

Question 7

What are some risk fx for UI in the young?

Answer 7

Pregnancy
Sports
Obesity
Chronic cough
(Anything causing inc. intra abdo pressure or weak pelvic floor)

Question 8

What are some contributing fx to UI in the elderly?

Answer 8

Meds- diuretics, NSAIDs, antihypertensives, antipsychotics, anticholinergics
Restricted mobility
Altered mental function
UTI
Severe constipation
Hyperglycaemia
Hypercalcaemia
Age-related LUT changes

Question 9

What are some red flags of UI?

Answer 9

Abrupt onset
Pelvic pain- associated w/ voiding
Haematuria

Question 10

What investigation is done if an UI red flag is present?

Answer 10

Cystoscopy

Question 11

What are some age-related LUT changes?

Answer 11

Decreased bladder contractility
Inc uninhabited bladder contractions
Dec bladder capacity
Weak sphincter striate muscle
Diurnal urine output late in the day
Inc post void residual vol (~1/3 of full capacity, 100-200ml in normal adult)
Decreased urethral closure pressure
Vaginal muscle atrophy- dry irritant causes urgency; oestrogen deficiency lead to stress UI and thin urethra

Question 12

What is the management for urge UI?

Answer 12

Bladder retraining
Anticholinergics
B3 agonist - mirabegron
Sacral nerve stimulation (T10-l5)

Question 13

What is the management for stress UI?

Answer 13

Pelvic floor muscle training

Surgical intervention

Question 14

What is the management for overflow UI?

Answer 14

Catheterisation

Surgical relief e.g. TURP

Question 15

What are the complications of UI in the elderly?

Answer 15

Pressure sores
Decline in mobility
Medication adherence problems
Decreased oral intake- confusion, AKI, postural hypotension, falls
Isolation, depression
Hygiene
Decreased inability to complete ADLs