Urinary Incontinence

Question 1

Define urinary incontinence?

Answer 1

The complaint of any involuntary leakage of urine

Question 2

Urinary incontinence is more common in men or women?

Answer 2

Women

Question 3

Urine can leak from the _1___ or __2___ route

___3_____ is most common and split into 4 categories which are _____4______

Answer 3

1) urethral
2) extra-urethral
3) urethral
4) overflow, urge, stress or mixed

Question 4

Define overflow incontinence?

Answer 4

Occurs due to bladder outflow obstruction meaning the bladder doesn’t empty properly when urinating and urine can leak out later as bladder too full.

Question 5

Early and late presentation of overflow incontinence?

Answer 5

Early: complain of painful urinary retention
Late: Palpable bladder, chronic retention, wet and night and renal impairment. Mass is dull to percussion.

Question 6

Causes of overflow incontinence?

Answer 6

More common in males (only type of incontinence more common in males) with benign prostatic hyperplasia
Other causes of outflow obstruction include bladder stones or tumours or other obstructions.

Question 7

Describe treatment of overflow incontinence

Answer 7

test renal function (as if obstruction been long standing and severe could have damaged the kidneys), treat obstruction with catheter, rehabilitate bladder, teach intermittent self catheterisation (unlikely to ever be able to pass urine spontaneously again)

Question 8

What type of urinary incontinence occurs due to bladder outflow obstruction?

Answer 8

Overflow incontinence

Question 9

Define overactive bladder syndrome

Answer 9

Urgency that occurs with or without urgency incontinence and usually with frequency and nocturia

Question 10

Patient presentation in urge incontinence?

Answer 10

Urinary frequency but only small voided volumes. Patients go to the bathroom frequently to avoid getting to the stage of uncontrollable passage of urine. There may be provocations to the urgency e.g. key in door, coughing, running water, laughing

Question 11

Urge incontinence is a form of bladder dysfunction characterised by _________

Answer 11

detrusor muscle contraction during inhibition of voiding. These contractions increase in amplitude which increases urgency until get uncontrollable passage of urine.

Question 12

How can different types of incontinence be diagnosed?

Answer 12

By urodynamics

Question 13

Most common cause of urge incontinence? Who is this common in?

Answer 13

Idiopathic detrusor over-activity

In middle aged females

Question 14

Causes of urge incontinence?

Answer 14

Most commonly idiopathic detrusor overactivity.
Other causes are cystitis due to infection or inflammation caused by stones or tumours
Excess central facilitation e.g. in stressful situations
Injury to spinal cord - high up injuries stops communication with the brain - low down injuries eliminate the whole reflex meaning nothing is controlling the bladder
Pelvic surgery or fractures can damage the parasympathetic nerves

Question 15

Increased frequency in stressful situations e.g. in an exam is caused by what type of incontinence?

Answer 15

Urge incontinence

Question 16

Detrusor muscle contraction during inhibition of voiding is a characteristic of what type of incontinence?

Answer 16

Urge incontinence

Question 17

Treatment of urge incontinence?

Answer 17

Diet changes e.g. avoid caffeine
Bladder diary (sometimes understanding habits is enough for someone to change them)
Bladder retraining
Time bladder emptying
Pharmacotherapy includes antimuscarinics e.g. oxybutynin, tolterodine. Beta 3 adrenergic e.g. mirabegron. Botulinum toxin.
Neuromodulation if nothing else works with bladder pacemaker
Last line= surgery

Question 18

Define Stress incontinence

Answer 18

Involuntary leakage on efforts or exertion or sneezing or coughing

Question 19

Define enuresis?

Answer 19

Involuntary urination

Question 20

What type of incontinence is being described?

Urine leaks due to increased intra abdominal pressure without a detrusor contraction?

Answer 20

Stress incontinence

Question 21

In stress incontinence is their detrusor contraction?

Answer 21

No urine leaks due to increased intra abdominal pressure

Question 22

What causes stress incontinence?

Answer 22

Due to damage of the pelvic floor or urethral function
most common in childbirth. Other causes are obesity, chronic coughing, diabetes, smoking, often a combination of many things

Question 23

Presentation of stress incontinence?

Answer 23

Complain of wetness when coughing or sneezing. Will also have frequency as they want to avoid full bladder as would become more wet if coughed or sneezed

Question 24

Treatment of stress incontinence?

Answer 24

Stop smoking, lose weight, pelvic floor exercises and physio
Pharmacotherapy doesn’t have a big role but duloxetine can be used to influence urethral tone.
Corrective surgery can be done.

Question 25

Explain what two types of incontinence are associated with frequency and why?

Answer 25

Urge incontinence: go often to avoid getting to uncontrollable passage of urine phase as detrusor contraction increases during inhibition of voiding phase
Stress: go frequently to avoid such a large leak of urine when coughing or sneezing

Question 26

Describe mixed incontinence?

Answer 26

common to have a mixed picture of stress and urge incontinence in women
Treated with a combination of different advice and therapy

Question 27

2 important extraurethral causes of incontinence?

Answer 27

ectopic ureter and vesico-vaginal fistula

Question 28

Describe an ectopic ureter and incontinence?

Answer 28

Baby with ureter that joins onto the wrong side of the urethra so urinates normally but also a constant wetness.

Question 29

Describe a vesico-vaginal fistula and incontinence?

Answer 29

Abnormal fistulous tract extending between the bladder and vagina that allows the continuous involuntary discharge or urine into the vaginal vault. Important in developing countries as common due to prolonged obstructed labour. In developing countries usually due to surgery.

Question 30

Describe difference in causes of vesico-vaginal fistula in developing vs developed countries?

Answer 30

Developing: occurs a lot due to prolonged obstructive labour as women walk miles to hospital in labour before able to give birth
Developed: Usually caused by surgery

Question 31

Define urge incontinence and urgency?

Answer 31

urinary incontinence is accompanied by or immediately preceded by urgency
urgency is the compelling desire to pass urine which is difficult to defer