Urinary incontinence

Question 1

Define stress incontinence

Answer 1

The external pressure to the bladder is greeater than the urinary sphincter pressure, causing urine to leak out.

Question 2

What is the cause of stress incontinence?

Answer 2

Reduced spincter closing pressure due to childbirth combined with raised intra-abdominal pressure such as junning, jumping, laughing, coughing, sneezing.

Question 3

What is the initial management for stress incontinence?

Answer 3

Reduce caffeine and fizzy drinks and pelvic floor physiotherapy?

Question 4

What is the medical management for stress incontinence?

Answer 4

Duloxetine (only recommended pharmaceutical intervention)

Question 5

What are the three available surgical treatments for stress incontinence?

Answer 5

Fascial sling: support urethra
Colposuspension: elevates bladder neck
Peri-urethral bulking

Question 6

Define urge incontinence

Answer 6

Overactive bladder: instead of storing urine, the bladder becomes irritated and contracts, causing urination before the patient can get to a toilet

Question 7

What is the initial management for urge incontinence?

Answer 7

Bladder diary, reduce caffeine and fizzy drinks and pelvic floor physiotherapy

Question 8

What is the medical management for urge incontinence?

Answer 8

Antimuscarinic anticholinergics: oxybutynin and tolterodine
AND
Topical vaginal oestrogens

Question 9

What invasive and surgical managements are available for urge incontinence?

Answer 9

Botox injections for detrusor muscle
Percutanoeous S3/posterior sacral nerve stimulation
Augmentation cystoplasty
Urinary diversion and urostomy formation

Question 10

What investigations make urodynamics?

Answer 10

Flow rate
Post-void residual volume
Spincter EMG
Cystometry - pressure and volume changes during filling and voiding

Question 11

What is the biggest risk factor for both types of incontinence?

Answer 11

Obesity (high BMI)