Urinary Incontinence

Question 1

What are the types of urinary incontinence?

Answer 1

1. stress
2. urgency
3. mixed
4. overflow
5. functional/ anatomical

Question 2

What is stress incontinence?

Answer 2

Stress incontinence is defined as the involuntary leakage of urine during increased intra-abdominal pressure (in the absence of a detrusor contraction).

It is typically seen after childbirth, which is the most common causative factor, having resulted in denervation of the pelvic floor. Other risk factors include oestrogen deficient states, pelvic surgery and irradiation.

Question 3

What is urge incontinence?

Answer 3

Urge incontinence (also known as overactive bladder syndrome) is the presence of urgency, usually with frequency and nocturia, in the absence of urinary tract infection or any other obvious pathology.

Urodynamic testing typically shows over-activity of the detrusor muscle. This is the type of incontinence seen in neurological conditions like multiple sclerosis or spina bifida – however most cases are idiopathic and some caused by pelvic/incontinence surgery itself.

Question 4

Name some other causes of urinary incontinence

Answer 4

Overflow incontinence – leakage of urine from an overfull urinary bladder, often in the absence of any urge to urinate.

Bladder fistulae – opening between the bladder and another organ (e.g. the vagina or rectum).

Urethral diverticulum – out-pocketing of the urethra into the anterior vaginal wall.

Congenital anomalies – e.g. ectopic ureter.

Functional incontinence – physical or mental barriers that prevent the patient reaching the toilet (e.g immobility, dementia).

Temporary incontinence – due to reversible factors such as constipation and urinary tract infection.

Question 5

investigations of urinary incontinence

Answer 5

urinalysis dipstick rule out infection
* Post-void residual (PVR) (bladder scan or catheter -
>50mL abnormal)
* Bladder stress test - cough test
* Urodynamic assessment (filling – cytometry; voiding –
uroflowmetry)

Question 6

mgmt of sui?

Answer 6

SUI – conservative > surgical
* Conservative – lifestyle changes, contributing factors,
pelvic floor exercises, biofeedback, bladder training,
topical vaginal estrogen, pessary, duloxetine (SNRI)
* Surgical – Tension-free Vaginal Tape, Trans-obturator
Tape, Burch Colposuspension

Question 7

mgmt of uui?

Answer 7

• Behavioral – lifestyle modifications, pelvic floor exercises, bladder training, + drug
• Medical – anticholinergic agents&raquo_space; (oxybutynin), beta 3 agonist (Mirebegron), TCAs, local estrogen
• Surgical – cystoscopy + intravesical Botox injection, Clam ileocystoplasty, urinary diversion