Urinary Incontinence in Women

Question 1

What does the sympathetic hypogastric nerve do in terms of the bladder?

Answer 1

Sympathetic = Storgage

Relaxes the bladder and contraction of urthrea to keep urine in place (T10-L2)

Question 2

What does the parasympathetic pelvic nerve do in terms of the bladder?

Answer 2

Parasympathetic = Power

Contraction of bladder and relaxation of urethra to get rid of urine

Question 3

What does the pudendal nerve do in terms of the bladder?

Answer 3

Voluntary control (contracting pelvic floor and urethral sphincters to avoid passing urine)

Question 4

What is urinary incontinence?

Answer 4

ANY involuntary leakage of urine

Question 5

What is stress urinary incontinence (SUI)?

Answer 5

Involuntary leakage on effort or exertion, on sneezing or coughing

Question 6

What is urge urinary incontinence (UUI)?

Answer 6

Involuntary leakage accompanied by or preceded by urgency

Question 7

What is mixed urinary incontinence (MUI)?

Answer 7

Involuntary leakage accompanied by or immediately preceded by urgency + on effort or exertion, sneezing or coughing

Question 8

Risk factors for UI?

Answer 8

• PREGNANCY AND CHILDBIRTH
• Age (older)
• Menopause
• Smoking
• Medical problems
• Chronic inc intra abdo pressure
• Pelvic floor trauma
• Degeneration
• Connective tissue disease
• Surgery

Question 9

Symptoms of UI?

Answer 9

• Irritation (e.g. urgency, frequency, nocturia, dysuria)
• Incontinence (stress, urgency, coital)
• Voiding symptoms (strainigng, flow, uti?)
• Fluid intake
• Effect on QoL

Question 10

How do you assess incontinence?

Answer 10

• 2/3 days urine diary

- urine dipstick

Question 11

Are any examinations carried out for UI?

Answer 11

• General/abdominal
• Neurological (if indicated by history)
• Gynaecological (prolapse, stress, atrophy changes, mass, pelvic floor)

Question 12

Investigations for UI?

Answer 12

• Urinalysis
• Post voiding residual volume assessment
• Urodynamics (only done if surgical treatment is contemplated)

Question 13

Management for UI?

Answer 13

• Lifestyle changes
• Medical treatment
• Physiotherapy
• Surgery

Question 14

How is UI managed conservatively?

Answer 14

• Normalise fluid intake
• Reduce caffeine, fizzy drinks, chocolate
• Stop smoking
• Weight loss
• Avoid constipation

Question 15

Pharmacological treatment for UI?

Answer 15

• Stress: Duloxetine

- Overactive bladder: Anticholinergics Mirabegron and vaginal oestrogen

Question 16

Other treatments for UI?

Answer 16

• Synthetic MUS (mesh)
• Autologus (rectus) fascial slings
• Colposuspension
• Urethral bulking