Urinary incontinence

Question 1

What are the types of incontinence

Answer 1

urgency
urge
nocturia
frequency
stress incontinence
mixed

Question 2

What are the two main types of incontinence?

Answer 2

stress and overactive bladder (umbrella term for urgency, urge, nocturia…)

Question 3

What is the mechanism of stress incontinence?

Answer 3

Weakening of urethral sphincter

Question 4

What is the mechanism of overactive bladder

Answer 4

overactive detrusor muscle

Question 5

What are the investigations for incontinence?

Answer 5

urine analysis +- MSU
pregnancy test
bladder diary
urodynamics

Question 6

What is the management of stress urinary incontinence?

Answer 6

conservative- physiotherapy, lifestyle modifications, bladder training
nothing
surgery

Question 7

List two surgeries for stress incontinence

Answer 7

autologous sling
colposuspension
urethral bulking agents

Question 8

What is the management of overactive bladder?

Answer 8

do nothing
conservative management
medical treatment
invasive therapy
reconstructive surgery

Question 9

What is the conservative management of OAB?

Answer 9

nurse-led

physio
reduce fluid intake
no caffeine

Question 10

What is the medical treatment for OAB?

Answer 10

1. anticholinergics
2. B3 agonist
3. duloxetine
4. anitbiotics

Question 11

Side effects of anticholinergics?

Answer 11

dry eyes
dry mouth
constipation

Question 12

What is mirabegron?

Answer 12

B3 agonist

Question 13

What is the contrainidcation for mirabegron?

Answer 13

prolongation of QT segment

uncontrolled hypertension

Question 14

Name an example of anticholinergic

Answer 14

oxybutinin
tolterodine
solfenacin

Question 15

Name one invasive treatment for overactive bladder

Answer 15

botox

Question 16

What is sacral neuromodulation

Answer 16

treatment option for OAB, last resort

Question 17

List three investigations for incontinence?

Answer 17

microbio
urodynamics
cystoscopy
USS
IV urography

Question 18

List three triggers for stress urinary incontinence

Answer 18

cough, laugh, run, walk, weight lifting, skipping

Question 19

List four causes of OAB

Answer 19

alcohol
caffeine
acute UTI
previous surgery
neurological- MS, stroke
high urine production- diabetes, fluids, medications
bladder abnormalities- tumours, stones

Question 20

List four risk factors associated with urinary incontinence

Answer 20

divided into predisposing, promoting, and obstertic and gynae causes

family hx, anatomical abnormalities, neuro abnormalities

drugs, menopause, UTI, obesity, age

Pegnancy, pelvic surgery, prolapse

Question 21

What lifestyle advice can you offer to someone with incontinence?

Answer 21

fluids- normalise intake
avoid caffeine, alcohol, carbonated drinks

diet, weight loss, smoking cessation, treat chronic cough and constipation

Question 22

List two surgical options for SUI

Answer 22

biological sling
intramural bulking agents
colposuspension

Question 23

How to divide bladder symptoms in history?

Answer 23

storage (before)

voiding (during)

post-micturation (after)

Question 24

What are the red flags for bladder symptoms associated with incontinence

Answer 24

visible haematuria
microscopic hameaturia >50
suspected malignant mass from urinary tract
recurrent or persisting UTIs in older women + haematuria

Question 25

Name two drugs which can worsen urinary incontinence

Answer 25

diuretics
doxazosin (alpha blocker)
ACEi (coughing)
sedatives and antipsychotics
opiates (urinary retention)

Question 26

Patient has rectocele prolapse and urinary incontinence. Will the surgery for their prolapse correct the urinary incontinence?

Answer 26

No!! In fact, it may worsen their urinary symptoms…the prolapse might actually be compressing the neck of the bladder which might help to minimise leakage