Urinary Incontinence

Question 1

Describe the physiology of urge urinary incontinence.

Answer 1

Uninhibited/Sudden detrusor muscle contraction/spasms

Question 2

Describe the physiology of overflow urinary incontinence

Answer 2

Overdistended, hypotonic bladder with no detrusor muscle contractions. Usually due to neurogenic failure.

Question 3

What comorbidities are most often associated with overflow incontinence?

Answer 3

• Diabetes mellitus
• Spinal cord injuries
• Multiple sclerosis
• Lower motor neuropathies
• Post-pelvic surgery usually 2º urethreal edema

Question 4

Compare and contrast the difference in symptoms between stress, urge, and overflow urinary incontinence.

Answer 4

Stress = incontinence with increase intra-abdominal pressure (cough, sneeze, lifting). No delay. øUrgency to void (urge or dysuria), Cystocele noticed
Urge = Urge to void (Have to pee but can't get there), dysuria, delayed incontinence with increase intra-abdo pressure
Overflow = Hx of neuropathy (spinal cord injury, DM, MS), dribbling, no urge to void, loss of urine with increase intra-abdo pressure

Question 5

What would you expect to find on physical examination with stress urinary incontinece?

Answer 5

Cystocele

Question 6

What investigation can determine whether you have stress or urge urinary incontinence diagnosis?

Answer 6

Urodynamic/cystometric examination

Urge urinary incontinence will show uninhibited contractions

Question 7

What test would you order to confirm overflow urinary incontinence?

Answer 7

Post-void residual ultrasonography

Question 8

What are some non-medical treatment options for stress urinary incontinence?

Answer 8

Pelvic floor strengthening exercises - Kegels
Avoiding heaving lifting
Controlled coughing
Constipation prevention
*Pessary (the above are lifestyle)

Question 9

What are medical treatment options for stress urinary incontinence?

Answer 9

Estrogen therapy if post-menopausal

Urethropexy with transvaginal tape sling is more definitive

Question 10

What are treatment options for urge urinary incontinence?

Answer 10

Anticholinergic Medication to relax detrusor muscle e.g. Oxybutynin (Ditropan)
*Avoid surgery!!

Question 11

How would you treat a patient with overflow incontinence?

Answer 11

Self-catheterization

Question 12

Describe the physiology of stress urinary incontinence?

Answer 12

• Normally intraabdominal pressure is ≤ urethra pressure.
• When there is a change in urethral angle (usually bladder prolapse) intraabdominal pressure ≥ urethra pressure = stress urinary incontinence