Urinary incontinence

Question 1

What is urinary incontinence?

Answer 1

An involuntary leakage of urine

Question 2

What are the 5 types of urinary incontinence?

Answer 2

Stress incontinence, urge incontinence, mixed incontinence, overflow incontinence, continuous incontinence

Question 3

What is stress incontinence?

Answer 3

Urine leakage occurring when the intra-abdominal pressure exceed the urethral pressure e.g. coughing, straining, laughing or lifting

Question 4

In stress incontinence what is usually weak?

Answer 4

Pelvic floor muscles

Question 5

When does stress urinary incontinence usually occur?

Answer 5

post- partum due to damage to pelvic floor muscles weakening the urethral sphincter

Question 6

What are other risks of stress incontinence?

Answer 6

Constipation due to straining, obesity, post menopausal, pelvic surgery

Question 7

What is urge incontinence?

Answer 7

Overactive bladder due to detrusor hyperactivity causing uninhibited bladder contraction leading to rise in intravesical pressure and subsequent leakage of urine

Question 8

What causes an overactive bladder?

Answer 8

neurogenic causes such as stroke, infection malignancy or idiopathic, medication like cholinesterase inhibitors

Question 9

What is mixed UI?

Answer 9

Stress UI and urge UI together

Question 10

What is overflow UI?

Answer 10

Chronic urinary retention complication where the progressive stretching of the bladder wall leads to damage to the efferent fibres of the sacral reflex and loss of bladder sensation, the bladder then becomes grossly distended as the bladder fills, however pressure builds and this causes constant dribbling

Question 11

What is the cause of overflow UI?

Answer 11

Prostatic hyperplasia but also spinal cord injury or congenital defects

Question 12

What is Continuous UI?

Answer 12

Constant leakage of urine meaning the patient is wet all the time. this is typically due to anatomical abnormality such (like ectopic ureter) or bladder fistula (vesicovaginal fistula) or sever overflow incontinence

Question 13

What examinations do you do for UI?

Answer 13

Enlarged prostate, prolapse, fistula

Question 14

What investigations do you need for UI?

Answer 14

Midstream urine dipstick, post void bladder scans, urodynamic assessment, outflow urodynamics to measure detrusor activity
cystoscopy

Question 15

What is the non surgical management for UI?

Answer 15

weight loss, reduce caffeine, avoid drinking and stop smoking

Question 16

What is the conservative management for UI?

Answer 16

Pelvic floor muscle training with duloxetine

Question 17

What is the conservative management for UI?

Answer 17

Anti-muscarinic drugs such as oxybutynin to inhibit detrusor contraction and bladder training

Question 18

What is the surgical management for Urge UI?

Answer 18

botulum toxin A injections, percutaneous sacral nerve stimulation, augmentation cytosplasty (detubularised segment of bowel is inserted into the bladder wall to increase bladder capacity, or urinary diversion via ileal conduit

Question 19

What is the surgical management for stress UI?

Answer 19

Tension free vaginal tape, open colposuspension (involving elevation of the bladder neck and urethra through a lower abdominal incision) intramural bulking agents or an artificial urinary sphincter