Urinary Incontinence

Question 1

Types of urinary incontinence

Answer 1

Stress
Urgency
Mixed
Overflow

Question 2

Treatment for stress incontinence

Answer 2

Pelvic floor exercises - before urodynamics

Duloxetine

Sling/ tape - surgery

Intramural urethral bulking

Question 3

Vesicular pressure components

Answer 3

Detrusor pressure + abdominal pressure

Question 4

Sphincter pressure components

Answer 4

Internal sphincter pressure + external sphincter pressure + abdominal pressure + pelvic floor pressure + urethral mucosa

Question 5

Investigating incontinence

Answer 5

Bladder diary

HbA1c - nocturia

USS - renal pathology

Urine analysis

Urine dynamics

Post void residual bladder volume

Cystoscopy

Question 6

Advice for incontinence

Answer 6

Avoid caffeine, fizzy drinks and alcohol

Regular toilet visits

Double voiding

Keep hydrated but not too much

Question 7

History of incontinence

Answer 7

Triggers?
Nocturia?
Frequency?
Hesitancy? 
Fluid intake?

Obstetric history?
Surgical history?

Question 8

Examination for incontinence

Answer 8

Scars

Abdominal distension

Prolapse

Pelvic floor tone

Visible incontinence

Obesity

CNS

Bimanual examination

Question 9

Treatment for detrusor overactivity - urgency

Answer 9

Bladder training

Antimuscarinics

Mirabegron

Botulinum injection - botox

Posterior tibial nerve stimulation

Sacral nerve stimulation

Clam enterocystoplasty

Question 10

Antimuscarinics for urge incontinence

Answer 10

• Oxybutynin
• Tolterodine
• Trospium
• Propiverine
• Solifenacin

Question 11

Pathophysiology of urge incontinence

Answer 11

Overactivity of the detrusor muscle of the bladder

Question 12

Presentation of urge incontinence

Answer 12

Not being able to hold urine in when the urge to urinate occurs

Question 13

Presentation of stress incontinence

Answer 13

Urine leakage with raised intra abdominal pressure such as laughing, coughing or surprise

Question 14

Pathophysiology of stress incontinence

Answer 14

Weakness of the pelvic floor and sphincter muscles

Question 15

Overflow Incontinence

Answer 15

Occurs with chronic urinary retention due to an obstruction to the outflow of urine

Question 16

Causes of overflow incontinence

Answer 16

Anticholinergic medications

Fibroids

Pelvic tumours

Neurological conditions such as multiple sclerosis, diabetic neuropathy and spinal cord injuries

Question 17

Women with overflow incontinence

Answer 17

More rare in women

Referred for urodynamic testing and specialist management

Question 18

Risk Factors for Urinary Incontinence

Answer 18

Increased age

Postmenopausal

Increase BMI

Previous pregnancies and vaginal deliveries

Pelvic organ prolapse

Pelvic floor surgery

Neurological conditions, such as multiple sclerosis

Cognitive impairment and dementia

Question 19

Urodynamic Testing

Answer 19

Thin catheter is inserted into the bladder and another into the rectum.

Measure the pressures in the bladder and rectum for comparison

Question 20

Intramural urethral bulking

Answer 20

Injections around the urethra to reduce the diameter and add support

Question 21

Side effects of anticholinergic medication

Answer 21

Dry mouth and eyes,

Urinary retention

Constipation

Postural hypotension.

Cognitive decline, memory problems and worsening of dementia

Question 22

When is mirabegron contraindicated

Answer 22

Uncontrolled hypertension

Requires blood pressure monitoring