urinary incontinence

Question 1

what is overactive bladder/urge incontinence

Answer 1

due to detrusor overactivity
urge to urinate is quickly followed by uncontrolled leakage

Question 2

what is stress incontinence

Answer 2

leaking small amounts of urine when coughing or laughing

Question 3

what is overflow incontinence

Answer 3

due to bladder outlet obstruction (prostate enlargement)

Question 4

what is functional incontinence

Answer 4

comorbid physical conditions impair the patients ability to get to the bathroom on time

Question 5

initial investigation for incontinence

Answer 5

bladder diaries for minimum of 3 days
vaginal examination
urine dipstick and culture
urodynamic studies

Question 6

management of urge incontinence

Answer 6

bladder retraining (minimum of 6 weeks)
bladder stabilising drugs (antimuscarinics)
- oxybutynin, tolterodine, darifenacin
mirabegron (beta-3-agonist) (useful if there is a concern about anticholinergeric side effects in frail elderly)

Question 7

management of stress incontinence

Answer 7

lifestyle measures (weight loss, caffeine)
pelvic floor muscle training
surgical- mid-urethral tape procedures, intramural bulking agent injections
duloxetine

Question 8

moa of duloxetine

Answer 8

increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve -> increased stimulation of urethral striated muscles within the sphincter - > enhance contraction