Urinary incontinence

Question 1

Describe the 4 types of urinary incontinance. (4)

Answer 1

Stress - involuntary leakage on effort or raised intra-abdominal pressure eg sneezing.
Urge - involuntary leakage preceded by urgency.
Overflow - retention to the point at which no more can be held.
Mixed

Question 2

Describe the three types of symptoms of urinary incontinence, and give examples of each. (6)

Answer 2

Storage issues - frequency, urgency, nocturia.
Voiding issues - slow stream, splitting, spraying, intermittency, straining.
Post-micturition - dribble, feeling of incomplete emptying.

Question 3

Describe the three categories of risk factors of urinary incontinence, and give examples of each. (6)

Answer 3

Predisposing - race, family history, anatomical or neurological abnormalities.
Promoting - obesity, age, increased intra-abdominal pressure, UTI, drugs, menopause, cognitive impairment.
O+G - pregnancy, childbirth, prolapse, pelvic surgery.

Question 4

Describe the examinations you would do if a person presented to you with incontinence. (3)

Answer 4

BMI, abdominal exam.
Male - prostate.
Women - vaginal.

Question 5

Describe the investigations you would do if someone presented with incontinence. (3)

Answer 5

Mandatory - urine dipstick.
Non-invasive - frequency-volume charts, bladder diary, pad tests.
Invasive - pressure-flow studies.

Question 6

Describe conservative management of incontinance. (7)

Answer 6

Modify fluid intake, weight loss, stop smoking, descrease caffeine, avoid constipation, pelvic floor muscle training, voiding schedule.

Question 7

Describe contained incontinence management of incontinence. (3)

Answer 7

For patients unsuitable for surgery: indwelling urethral or suprapubic catheter, condom catheters, incontinence pads

Question 8

Describe pharmacological managements of incontinence. (4)

Answer 8

SSRIs - increase sphincter activity.
Anticholinergics - reduce detrusor contraction by acting on muscarinics of paracympathetics.
B3 agonists - increase bladder capacity.
Botox - reduces effectiveness of detrusor muscle.

Question 9

Describe surgery as a management for incontinence.

Answer 9

In women can be temporary (if having more children - intramural bladder neck bulking), or permanent (low tension vaginal tapes or fasciae sling procedure).
In men is permanant - artificial sphincters, or male slings.
In both - sacral nerve modulation or urinary diversion.