Urinary Incontinence

Question 1

Describe types of UI

Answer 1

Stress UI- involuntary with effort, sneeze, cough
Urgency UI- involuntary with urgency
mixed UI- both
overflow UI- overdistended full bladder, incomplete emptying, dribbling (eg under active detrusor or bladder obstruction)

Question 2

What might overactive bladder syndrome present with

Answer 2

Frequency, urgency, nocturia

Question 3

Risk factors for UI

Answer 3

Pelvic prolapse, vaginal childbirth, pregnancy, age, menopause, obesity, UTI

Question 4

What two receptors are very important in micturition and bladder storage

Answer 4

M3 is the parasympathetic that activates detrusor for voiding
B3 is the sympathetic that inhibits detrusor for storing

Question 5

Describe treatment for stress UI

Answer 5

Pelvic floor training x8 contractions x3 day for 3months

Also surgery eg sling, artificial urinary sphincter

Question 6

Describe treatment for urge UI

Answer 6

Bladder training, only empty bladder at allowed timepoints and build to 2-3hours
Drugs are anticholingerics to antagonise m3
Or b2 agonists to help inhibiting detrusor
If these don’t work try botulinum toxin to inhibit ACh of parasympathetic
Surgery is sacral nerve neuromodulation or augmentation cystoplasty which makes bladder larger

Question 7

What’s the basic problem in urge UI

Answer 7

Overactive bladder

Question 8

What’s the basic problem in stress UI

Answer 8

Underactive sphincters