Urinary incontinence

Question 1

Define what urinary incontinence is

Answer 1

The complaint of any involuntary leakage of urine

Question 2

What are the 4 types of urethral urinary incontinence ?

Answer 2

• Urge
• Stress
• Mixed
• Overflow

Question 3

What are 2 other examples of urinary incontinence other than urethral ones ?

Answer 3

Due to extraurethral route - e.g. ectopic ureter draining straight into the urethra or a fistula

Question 4

Describe the symptoms/signs of overflow incontinence

Answer 4

• It is due to bladder flow obstruction causing urine to build up resulting in chronic retention then eventually the person is incontinent
• Large palpable bladder
• Usually don’t feel that they are incontinent
• Often wet at night

Question 5

Who is usually affected by overflow incontience ?

Answer 5

Men - as can be caused commonly by enlargement of the prostate

Question 6

Describe the signs/symptoms of urge incontinence

Answer 6

• You have an urgent desire to pass urine and sometimes urine leaks before you have time to get to the toilet
• Sometimes provoked by things e.g. putting the key in the door, sound of running water etc

Question 7

What is urge incontinence often due to ?

Answer 7

Detrusor overactivity - which is essentially due to overstimulation by nerves

Question 8

What are some of the causes of detrusor overactivity ?

Answer 8

• Tumours or bladder stones causing irritation in the bladder
• Pelvic surgery or fractures causing damage to the parasympathetic supplying the bladder
• Paraplegia - loss of central inhibition
• Destruction of S2,3 segment
• Infection

Question 9

How is detrusor overactivity diagnosed ?

Answer 9

By Cystomethogram – Urodynamics

Question 10

What is detrusor overactivity characterised by on urodynamics?

Answer 10

Rise in detrusor pressure causing rise in intravesicular pressure with no increase in abdominal pressure

Question 11

What are the signs/symptoms of stress incontinence ?

Answer 11

• Urine leaks during increased intra abdominal pressure, without a detrusor contraction
• e.g. when coughing can get leaks, can be due to weak pelvic floor muscle due to pregnancy

Question 12

What is the most common type of urinary incontinence ?

Answer 12

Stress incontinence

Question 13

How is stress incontinence diagnosed ?

Answer 13

Urodynamic studies

Question 14

What are the characteristics of stress incontinence on urodynamic studies ?

Answer 14

Will show increased abdominal pressure corresponding to increased filling without increased detrusor pressure

Question 15

What is the treatment of overflow incontinence ?

Answer 15

• Catheterise to relieve the urine
• Treat the obstruction
• Rehabilitate the bladder
• Assess renal function - as the blockage can cause backflow leading to hydronephrosis (diagnose with US)

Question 16

What is the treatment of urge urinary incontinence ?

Answer 16

1st line = dietary (avoid caffeine) and bladder training and pelvic floor strengthening

2nd line:

• Antimuscarinics - (e.g. oxybutynin, tolterodine)
• Beta 3 adrenergics (mirabegron)

Question 17

What is the treatment of stress incontinence ?

Answer 17

• 1st line = lifestyle (weight loss, stop smoking) and physio (pelvic floor exercises)
• Surgical correction is the mainstay - either colposusspension or tape procedures

Question 18

Define stress incontinence

Answer 18

Involuntary leaking on effort or exertion, or on sneezing or coughing.

Question 19

Define urge incontinence

Answer 19

Involuntary leakage accompanied by, or immediately preceded by urgency.

Question 20

Define mixed urinary incontinence

Answer 20

Involuntary leakage associated with urgency and also with exertion- effort, sneezing or coughing.