Urinary Incontinence

Question 1

Urinary incontinence

Answer 1

Involuntary leakage of urine

Question 2

Conditions what is urgency,stress and mixed?

Answer 2

Urgency incontinence - sudden immediate need to pass urine that is difficult to delay
Stress incontinence - leakage on effort or exertion or on sneezing or coughing
Mixed incontinence - urgency and stress,however one type tends to be predominant

Question 3

Risk factors

Answer 3

• old age
• pregnancy + vaginal delivery
  Obesity ,smoking
• constipation
• family history
• medicines (diuretics, alcholohol and caffeine all increase urine production and can exacerbate incontinence

Question 4

Treatment : NON DRUG??? And the what? In terms of drugs? Mixed, non drug, stress who gets duloxetine? What for 6 weeks? How long with mixed

Answer 4

Non drug - modify fluid intake,weight loss if obese,reduce caffeine
Urgency -
. First line - bladder training for at least 6 weeks
.second line - anti Musca rain is (oxybutynin or tolteriodine)
Third :mirabegron

Stress:
- pelvic floor exercises for at least 3 months
- surgery or duloxetine

Mixed
Balder training (more than 6 weeks)+ pelvic floor muscle training for mor than 3 months
- treat pharmacologically in accordance to dominating type

Question 5

Antimuscarinics examples and who can they increase adverse effects in? Remember and who is it contradicted in with eyes? What can antimuscarinics affect?

Answer 5

Fesoteridone, solifenacin, trospium, oxybutynin, toterodine

Increase adverse effects in elderly - constipation, dry mouth, flushing, dizziness, drowsiness, tachycardia

Contraindicated - angles - closure glaucoma, gastro - intestinal obstruction

Antimuscarinics can affect the performance of skilled tasks - eg, driving

Question 6

Nocturnal enuresis is what? Who is it common in?

Answer 6

Involuntary urination during sleep - common in children

Question 7

Non drug treatment - ND for children under 5

Answer 7

Children under 5 - should resolve without intervention

• advice on fluid intake, diet , toilet behaviour and use of reward system

Question 8

No response to advice - more than 1-2 wet bed per week is unnecessary what can we add or replace it with?

Answer 8

Enuresis alarm
- alarms in less than 7 depending on maturity, motivation and understanding
- alarms have less relapse than drug treatment when discontinued
- review alarm after 4 weeks
- continue until a minimum of 2 weeks of uninterrupted dry nights
- if alarm treatment is unsuccessful : add in /replace with desmopressin

Question 9

Drug treatment in children? When could we give imipramine?

Answer 9

Children over 5 - desmopressin
- if alarm is undesirable
- when needed rapid results to cover things like holidays
- assess treatment after 4 weeks and continue for 3 months if patient is responding
- repeated courses should be withdrawn gradually at regular intervals

Specialist - desmopressin +/- Antimuscarinics(oxybutynin or tolterodine)
- not responding to all other treatments - imipramine

Question 10

Desmopressin more potent than what? What are its side effects?

Answer 10

More potent and longer duration of action than vasopressin
- no vasoconstriction effect
- side effect - hyponatraemia, nausea