Urinary Incontinence

Question 1

COMMS: Explanation of bladder

Answer 1

• Bladder is a muscular organ that sores urine, expanding when filled
• Outlet of the bladder leads to the urethra which is normally closed with the help of pelvic floor muscles
• Normally messages from bladder to brain say when bladder is full and then the brain can relay signals to bladder for when pelvic floor muscles need to be relaxed so urine can pass

Question 2

Define stress incontinence

Answer 2

• This is the leakage of urine when extra pressure is placed on the bladder
• Usually occurs during coughing, laughing or exercise

Question 3

What causes stress incontinence?

Answer 3

• Weak pelvic floor muscles due to childbirth
• Increasing age (esp after menopause)
• Obesity

Question 4

What is the conservative management of stress incontinence?

Answer 4

1. Pelvic floor exercises
   - squeeze muscels above entrance to anus
   - Imagine trying to stop urination
   - 3 x every day
2. Lifestyle: incontinence pads, access to toilet, losing weight, stop smoking
3. Electrical stimulation/biofeedback, vaginal cones

Question 5

What are the medical and surgical options for stress incontinence?

Answer 5

MEDICAL
-Duloxetine helps muscles around urethra to contract

SURGICAL
-Tension free vaginal tape (day case, 80-90% cure rate)

Question 6

Define overactive bladder/urge incontinence?

Answer 6

-Sudden urgent desire to pass urine and not able to withhold

Question 7

What causes OAB?

Answer 7

• Unknown
• Exacerbated by stress/caffeine/alcohol
• UTI or bladder stones

Question 8

How is OAB managed?

Answer 8

1. Bladder retraining (lasts for a minimum of 6 weeks, the idea is to gradually increase the intervals between voiding)

MEDICAL
-Antimucarinic
(OXYBUTYNIN 1st line)
SE: dry mouth, dry eyes, constipation, blurred vision

SURGICAL (rare)

• Sacral nerve stimulation
• Urinary diversion
• Botulinum toxin