Urinary incontinence

Question 1

What are the 2 types of urinary incontinence?

Answer 1

Urge incontinence and stress incontinence

Question 2

1) What is urge incontinence caused by?
2) What is the typical description of urge incontinence?

Answer 2

1) Overactivity of the detrusor muscle of the bladder
2) Suddenly feeling the urge to pass urine, having to rush to the bathroom and not arriving before urination occurs

Question 3

1) What causes stress incontinence?
2) What is the typical description of stress incontinence?

Answer 3

1) Weakness of the pelvic floor and sphincter muscles which allows urine to leak at times of increased pressure on the bladder
2) Urinary leakage when laughing, coughing or surprised

Question 4

Name 3 risk factors for urinary incontinence

Answer 4

• Increased age
• Postmenopausal status
• Increased BMI
• Previous pregnancies and vaginal deliveries
• Pelvic organ prolapse
• Pelvic floor surgery
• Neurological conditions i.e. MS
• Cognitive impairment and dementia

Question 5

Management of urge incontinence
1) What is 1st line treatment?
2) What are the 1st line bladder stabilising drugs, and give an example
3) What drug can be given to avoid use of anticholinergics, and what type of drug is it?

Answer 5

1) Bladder retraining (6 weeks)
2) Anticholinergics - tolterodine, oxybutynin
3) Mirabegron - beta 3 agonist

Question 6

Management for stress incontinence
1) What is 1st line treatment?
2) What is the main surgical procedure offered?
3) What drug can be given if surgery isn’t an option/doesn’t work, and what kind of drug is it?

Answer 6

1) Pelvic floor exercises
2) Tension-free vaginal tape
3) Duloxetine - SNRI antidepressant