Urinary Incontinence

Question 1

What is UI?

Answer 1

• Involuntary leakage of urine

Question 2

What are the different types of UI?

*7 types

*FUSMOOT

Answer 2

• Functional Incontinence
• Stress Incontinence
• Urge Incontinence
• Mixed Incontinence
• Overactive Bladder Syndrome
• Overflow Incontinence
• True Incontinence

Question 3

What is functional incontinence?

Answer 3

• patient is unable to reach the toilet in time
  
  • poor mobility or unfamiliar surroundings

Question 4

What is stress incontinecne?

Answer 4

• involuntary leakage of urine on effort or exertion
  
  • incompetent sphincter

Question 5

What is urge incontinence?

Answer 5

• involuntary urine leakage accompanied by, or immediately preceded by, urgency of micturition
  
  • detrusor instability or hyperreflexia
    
    • involuntary detrusor contraction

Question 6

What is mixed incontinence?

Answer 6

• involuntary leakage of urine associated with both urgency and exertion

Question 7

What is overactive bladder syndrome?

Answer 7

• urgency that occurs with or without urge incontinence and usually with frequency and nocturia

Question 8

What is overflow incontinence?

Answer 8

• due to chronic bladder outflow obstruction
  
  • prostatic disease in men

Question 9

What is true incontinence?

Answer 9

• Continuous leakage of urine
• fistulous track between the vagina and the ureter, or bladder, or urethra

Question 10

What are the RF of UI?

Answer 10

• Women
• Pregnancy, parity
• Vaginal delivery
• Vaginal hysterectomy
• UTI
• Neurological disease
  
  • stroke, dementia, parkinsons
• Enlarged protsate
• Stool impaction

Question 11

What questions will you enquire to assess the type of incontinence?

Answer 11

• Stress incontinence: leakage of urine on sneezing, coughing, exercise, rising from sitting, or lifting.
• Urge incontinence: urgency and failure to reach a toilet in time.
• Frequency of urine during the day/at night.
• Dribbling of urine after leaving the toilet.
• Loss of bladder control.
• Feeling of incomplete bladder emptying.
• Dysuria: pain or burning sensation on passing urine.
• Bladder spasms

Question 12

What other questions would you ask to enquire more about the incontinence?

Answer 12

• consider neurological causes - hand co-ordination, cognitive function
• A full obstetric history
• The patient should be asked to complete a bladder chart for a minimum of three days.
• Enquire about sexual dysfunction and quality of life.
• Assess functional status and access to toilet.
• Establish whether any medication contributes to symptoms.
• Enquire about bowel habit.
• Enquire about desire for treatment

Question 13

What examination would you perform for UI?

*list both women and men

Answer 13

women

• Digital assessment of pelvic floor contraction
• vaginal examination - assess for prolapse
• signs of vaginal atrophy
• abdo, pelvic and neuro examination

men

• DRE - prostate and anal strength
• abdo, pelvic and neuro examination

Question 14

WHat ix would you order for UI?

Answer 14

• urinary dipstick testing - infection or haematuria
• MSU for MCS if UTI +
• Post-void bladder scan
• urodynamic assessment
• outflow urodynamics
• cystoscopy
• IV urogram
• MRI

Question 15

When is urodynamic testing only considered?

Answer 15

• suspected detrusor over-activity
• symptoms suggestive of voiding dysfunction
• have had previous surgery for stress UI

Question 16

How would you mx UI?

Answer 16

• Conservative
  
  • reduce caffeine intake
  • lose weight if high BMI
  • bladder training - min 6weeks
• Pharm
  
  • anticholinergics (antimuscarinic drugs)
    
    • oxybutynin, propiverine, tolterodine, darifenacin
• Secondary care tx
  
  • Botulinum Toxin A
  • Sacral nerve stimulation
  • Percutaneous posterior tibial nerve stimulation (PTNS)
  • Laparoscopic augmentation cystoplasty

Question 17

How would you mx SI?

Answer 17

• Conservative
  
  • Pelvic floor exercise - 3months
• Pharm
  
  • Duloxetine
• Surg
  
  • Open colposuspension
  • Autologous rectus fascial sling

Question 18

How would you mx MI?

Answer 18

• Conservative
  
  • Pelvic floor exercise
• Pharm
  
  • Antimuscarinics - Oxybutynin
  • darifenacin, solifenacin, tolterodine and trospium are alternatives

Question 19

How would you mx OI?

Answer 19

• relieve or tx obstruction
• Intermittent self-catheterisation

Question 20

What medications causes stress incontinence?

Answer 20

• alpha adrenergic antagonist
  
  • tamsulosin
  • doxazosin

Question 21

What medications cause urge incontinence?

Answer 21

• diuretics
• caffiene

Question 22

What medications cause overflow incontinence?

Answer 22

• Anticholinergics
  
  • anti depressants, anti psychotics, anti histamines
• Nervous System depressant
  
  • CCB
  • alpha blockers
  • beta blockers
  • narcotics
  • alcohol