Urinary Incontinence

Question 1

Define “urinary incontinence”

Answer 1

Involuntary leakage of urine

Question 2

List the main urethral forms of incontinence

Answer 2

Overflow incontinence
Urge incontinence
Stress incontinence
Mixed incontinence

Question 3

What happens in overflow incontinence?

Answer 3

Bladder continuously fills up due to obstruction and eventually overflows
Hugely palpable bladder, can cause renal impairment

Question 4

What is meant by urge incontinence?

Answer 4

Urgent desire to pass urine and unable to hold it in leading to involuntary leakage
Women who leak (bladder spasms)

Question 5

What is the main cause of urge incontinence?

Answer 5

Detrusor overactivity during inhibition of voiding, making it impossible not to let it go
https://www.youtube.com/watch?v=0W_SGoBFJxs

Question 6

What is meant by stress incontinence?

Answer 6

Urine leaks during increased abdominal pressure, usually due to pelvic floor damage or urethral dysfunction WITHOUT DETRUSOR CONTRACTION
Women after childbirth/ menopause

Question 7

Give examples of things that can precipitate stress incontinence

Answer 7

Laughing
Coughing
Jumping
Basically anything that increases abdominal pressure

Question 8

List management for overflow incontinence

Answer 8

Assess renal function
Treat obstruction - catheterise
Bladder rehab

Question 9

List conservative management for urge incontinence

Answer 9

Reduce caffeine intake
Bladder training (time bladder emptying)

Question 10

List pharmacotherapy for urge incontinence

Answer 10

Antimuscarinic - oxybutynin, tolterodine
Beta-3-agonist - mirabegron
Botulinum toxin injection

Question 11

List conservative management for stress incontinence

Answer 11

Reduce caffeine intake
Pelvic floor exercises/physiotherapy
Stop smoking/ weight loss

Question 12

List extraurethral causes of urinary incontinence

Answer 12

Ectopic ureter (hydronephrosis at birth)
Vesico-vaginal fistula (difficult childbirth in developing countries)

Question 13

Urinary incontinence is more common in males/females. Why?

Answer 13

Females
Shorter urethra
Only one sphincter

Question 14

List risk factors for urinary incontinence

Answer 14

Age, Gender, Genetic
Neurological (spinal cord)
Anatomy (fistula), Childbirth
Pelvic surgery, Radiotherapy
Diabetes
Smoking (cough), Obesity, Poor mobility, Poor nutrition, Increased fluids
UTI
Medications (alpha blocker)
Cognitive impairment
Oestrogen deficiency

Question 15

List key points to cover in a urinary incontinence history

Answer 15

Onset, duration, frequency
Triggers
Classic symptoms (dysuria, haematuria)
Bowel habit
PMHx: Childbirth, MSK
DHx

Question 16

Which physical exams should be considered in urinary incontinence?

Answer 16

Abdominal exam (palpable bladder)
PR exam (prostate)

Question 17

List investigations used in urinary incontinence

Answer 17

International consultation on incontinence questionnaire
3 day bladder diary
Uroflometry (how much urine is passing)
Urinalysis, FBC, U+Es
Pad test

Question 18

What is the main diagnostic technique used to diagnose stress incontinence?

Answer 18

USI (urodynamics)

Question 19

List surgical management for urge incontinence

Answer 19

Neuromodulation (bladder pacemaker)

Enterocystoplasty (ileal conduit)

Question 20

List pharmacotherapy for stress incontinence

Answer 20

SNRI - duloxetine

Question 21

List surgical management for stress incontinence

Answer 21

Open calposuspension - minimally invasive tape procedure (sling to support urethra under pelvic floor)

Question 22

What is the main principle of management for mixed incontinence?

Answer 22

Which is more dominant out of urge and stress incontinence?