Urinary incontinence

Question 1

Urinary incontinence

Urinary incontinence (UI) is a common problem, affecting around 4-5% of the population. It is more common in elderly females

Risk factors

Answer 1

• advancing age
• previous pregnancy and childbirth
• high body mass index
• hysterectomy
• family history

Question 2

Urinary incontinence

Classification

Answer 2

• overactive bladder (OAB)/urge incontinence: due to detrusor over activity
• stress incontinence: leaking small amounts when coughing or laughing
• mixed incontinence: both urge and stress
• overflow incontinence: due to bladder outlet obstruction, e.g. due to prostate enlargement

Question 3

Urinary incontinence

Initial investigation

Answer 3

• bladder diaries should be completed for a minimum of 3 days
• vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
• urine dipstick and culture

Question 4

Urinary incontinence

Management

Urge

Answer 4

Management depends on whether urge or stress UI is the predominant picture. If urge incontinence is predominant:

• bladder retraining (lasts for a minimum of 6 weeks, the idea is to gradually increase the intervals between voiding)
• bladder stabilising drugs: antimuscarinic is first-line. NICE recommend oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation). Immediate release oxybutynin should, however, be avoided in ‘frail older women’

Question 5

Urinary incontinence

Management

Stress

Answer 5

Management depends on whether urge or stress UI is the predominant picture.

If stress incontinence is predominant:

• pelvic floor muscle training: NICE recommend at least 8 contractions performed 3 times per day for a minimum of 3 months
• surgical procedures: e.g. retropubic mid-urethral tape procedures