Urinary Incontinence

Question 1

what are the risk factor for urinary incontinence?

Answer 1

> parity
> age
> menopause
> smoking
> increased intrabdominal pressure
> pelvic floor trauma
> connective tissue disease
> surgery
> denervation

Question 2

what are the voluntary nerves for bladder control?

Answer 2

pudendal nerve S2-4

Question 3

what nerves are involved in storage?

Answer 3

> hypogastric nerve

sympathetic

Question 4

what nerves are involved in voiding?

Answer 4

> pudendal nerve S2-4

parasympathetic

Question 5

what is urinary incontinence?

Answer 5

any involuntary leakage of urine

Question 6

what is stress urinary incontinence?

Answer 6

involuntary leakage on exertion

Question 7

what is urge urinary incontinence?

Answer 7

involuntary leakage accompanied by urgency

Question 8

what is mixed urinary incontinence?

Answer 8

involuntary leakage accompanied by urgency and on excretion

Question 9

what irritation symptoms are seen in incontinence?

Answer 9

> nocturia
increased daytime frequency
dysuria
haematuria

Question 10

what voiding symptoms are seen in incontinence?

Answer 10

> straining to void
interrupted flow
recurrent UTI

Question 11

what do you want from the history in incontinence?

Answer 11

> QOL
> parity
> mode of delivery
> weight and heaviness of the baby
> HRT

Question 12

what investigation would you carry out in urinary incontinence?

Answer 12

> urine dipstick
> 3 day urinary diary 
 - nocturia
 - fluid intake
 - urine output
 - daytime frequency
 - average voided urine
> post voiding residual volume assessment
> urodynamics (if surgical intervention is being contemplated)

Question 13

what are the risk factors for over active bladder syndrome?

Answer 13

> Age
UTI
smoking
diabetes

Question 14

what is overactive bladder syndrome?

Answer 14

a symptom complex usually but not always related to urodynamically demonstrable detrusor activity

Question 15

what symptoms are seen in overactive bladder syndrome?

Answer 15

> incontinence
frequency
nocturia

Question 16

what is the management of overactive bladder syndrome?

Answer 16

> life style intervention
 - normalise fluid intake
 - reduce caffeine
 - weight loss
> bladder retraining
 - timed bladder emptying programme
> pharmacological
 - antimuscarinics [solifenacin]
 - tricyclic antidepressants
> neuromodulation
 - reflex inhibition to the detrusor muscle
 - needle stimulation

Question 17

what management options are there for urinary incontinence?

Answer 17

> life style changes
> pelvic floor muscle training
> pharmacological 
 - [duloxetine]
> surgery
 - trans obturator tape
 - tension free vaginal tape

Question 18

when is pharmacological treatment given?

Answer 18

> doesn’t want surgery
not fit for surgery
after failed surgery
if family is not yet complete

Question 19

what are dome complications from urinary incontinence surgery?

Answer 19

> vascular injury
vaginal erosions
bladder perforation