Urinary incontinence

Question 1

Define urge incontinence.

Answer 1

Involuntary leakage of urine which is accompanied or preceded by an “urge” to pass urine.

Question 2

What is overactive bladder syndrome?

Answer 2

Increased frequency + nocturia, not necessarily with incontinence
If incontinent; classed as urge incontinence

Question 3

What is stress incontinence?

Answer 3

involuntary leakage of small amounts of urine when there is increased intra-abdominal pressure e.g. coughing, laughing

Question 4

What is mixed incontinence?

Answer 4

Urge + stress incontinence

Question 5

What causes overflow incontinence?

Answer 5

Detrusor under activity or bladder outlet obstruction causing urinary retention + leakage of urine

Question 6

What causes continuous incontinence?

Answer 6

severe mixed incontinence
or
due to a fistula e.g. vesicovaginal fistula- dribbling

Question 7

What causes urge incontinence?

Answer 7

Detrusor overactivity

Urge to urinate is quickly followed by uncontrollable leakage ranging from a few drops to complete bladder emptying

Question 8

What is functional incontinence? What causes it?

Answer 8

Comorbid physical conditions impair ability to get to a bathroom in time
Causes:
dementia
Sedating medication
Injury/ illness resulting in decreased ambulation

Question 9

What are 4 risk factors of urge incontinence?

Answer 9

Age

Obesity

FH

Diabetes

Question 10

What are 5 risk factors of stress incontinence?

Answer 10

Age

Traumatic delivery (Forceps)

Smoking

Obesity

Previous pelvic surgery

Question 11

What 4 investigations should be performed for urinary incontinence?

Answer 11

Bladder diaries for min. 3 days

Vaginal examination to exclude pelvic organ prolapse + ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)

Urine dipstick + culture

Urodynamic studies

Question 12

What investigation should be performed if vesicovaginal fistula is suspected?

Answer 12

Urinary dye studies

Question 13

What causes stress incontinence?

Answer 13

Pelvic floor weakness/ intrinsic sphincter deficiency

Question 14

What conservative advice can be given to those with urinary incontinence?

Answer 14

Avoid caffeinated drinks

Avoid drinking excessive/ reduced amounts of fluids daily

Weight loss if BMI >30

Smoking cessation (stress incontinence)

Question 15

What is the firstline management for stress incontinence?

Answer 15

Pelvic floor muscle training
At least 8 contractions performed 3x per day for min 3/12

Question 16

What is the medical management for stress incontinence?

Answer 16

Duloxetine: enhances sphincter contraction
r/v in 2-4w if unsuitable for surgery/ prefer pharmacological

Question 17

What is the surgical management for stress incontinence?

Answer 17

Colposuspension: lift neck of bladder + fix to Coopers ligaments

Autologous rectus fascial sling or Retropubic mid-urethral mesh sling: elevate urethra

Intramural urethral bulking agents: inject bulking agent around urethra

Question 18

What is the first line treatment for urge incontinence?

Answer 18

Bladder retraining for 6w
Gradually increase intervals between voiding

Question 19

What is the medical management for urge incontinence?

Answer 19

Antimuscarinics:
Oxybutinin, Tolterodine, Darifenacin

Question 20

Which drug should be avoided in frail older women with urge incontinence? What should be used instead?

Answer 20

Avoid Oxybutinin due to anticholinergic SE

Use Mirabegron

Question 21

What surgical procedures can be used for urge incontinence?

Answer 21

Botox injection

Percutaneous tibial nerve stimulation
Sacral nerve stimulation

Question 22

What is the risk associated with botox infections for urge incontinence?

Answer 22

Temporary urinary retention
Need to be willing to self catheterise