Urinary Incontinence

Question 1

Risk factors

Answer 1

advancing age
previous pregnancy and childbirth
high body mass index
hysterectomy
family history

Question 2

Types of incontinence

Answer 2

1) overactive bladder (OAB)/urge incontinence
> detrusor overactivity

2) stress incontinence

3) mixed incontinence: both urge and stress

4) overflow incontinence
> due to bladder outlet obstruction, e.g. prostate enlargement

5) functional incontinence
> comorbidities impairing ability to get to bathroom

Question 3

Investigations

Answer 3

• bladder diaries
• vaginal examination to exclude prolapse
• urine dipstick and culture
• urodynamic studies

Question 4

Management of urge incontinence/overactive bladder

Answer 4

• bladder retraining
• bladder stabilising drugs
  > oxybutynin
  > tolterodine
  > solifenacin
• mirabegron (a beta-3 agonist)

Question 5

Management of stress incontinence?

Answer 5

• pelvic floor muscle training
• Surgery e.g. retropubic mid-urethral tape procedures
• Duloxetine
  > combined noradrenaline and serotonin reuptake inhibitor
• stimulates pudendal nerve and urethral striateed muscle contraction