Urinary Incontinence

Question 1

What are risk factors for urinary incontinence?

Answer 1

Old age
Pregnancy and vaginal delivery
Obesity, Smoking
Constipation
Family history
Medicines (diuretics, alcohol, ceffeine)

Question 2

What is advice you should give to someone with urinary incontinence?

Answer 2

Modify fluid intake
Weight loss if obese
Reduce caffeine
Medication review - stop meds

Question 3

Whats the treatment options for Urgency incontinence?

Answer 3

1st: Bladder training for at least 6 weeks
2nd: Antimuscarinic e.g. immediate release Oxybutynin or Tolterodine or Darifenacin
3rd: Mirabegron

Question 4

When should oxybutinin not be used for urgency incontinence?

Answer 4

frail patients or older women at risk of sudden deterioration of their physical or mental health.

Question 5

What formulation can be used if patients cant take oral antimuscarinics?

Answer 5

Transdermal oxybutynin

Question 6

When should incontinence treatment be reviewed?

Answer 6

Maximum 4 weeks, then again at 12 weeks and then annually unless the woman is over 75 years of age.

Question 7

What should you do if the first treatment is ineffective?

Answer 7

Try another first line or mirabegron or an extended release formulation.
Can also try fesoterodine, propiverine, solifenacin, trospium

Question 8

If a patient has been taking medications for an overactive bladder and they have failed what do you do?

Answer 8

refer them to secondary care for botox injection or surgery

Question 9

Whats the treatment options for Stress incontinence?

Answer 9

1st: Pelvic floor muscle training for atleast 3 months
2nd: Surgery but if not appropriate or patient wants drug treatment then Duloxetine

Question 10

Whats the treatment options of a mixture of urgency and stress incontinence?

Answer 10

1st: Bladder training for atleast 6 weeks and pelvic floor muscle training for atleast 3 months
2nd: Treat pharmacologically in accordance to the most dominating type

Question 11

What are the antimuscarinics?

Answer 11

Fesoterodine, solifenacin, trospium, oxybutynin, tolterodine

Question 12

What are the examples of increased adverse effects that are seen in the elderly with antimuscarinics?

Answer 12

Constipation, Dry mouth, Flushing, Dizziness, Tachycardia

Question 13

What are antimuscarinics contraindicated in?

Answer 13

Angle-closure glaucoma
GI obstruction

Question 14

What is something you should counsel patients on when they take this?

Answer 14

Can affect the performance of skilled tasks.

Question 15

In what patients can duloxetine only be used in?

Answer 15

Women