Incontinence

Question 1

What % of the population are affected by urinary incontinence?

Answer 1

4-5%

Question 2

What demographic is most likely to be affected?

Answer 2

Elderly females

Question 3

What are the 4 types of incontinence?

Answer 3

1. Urge Incontinence (Overactive bladder - OAB)
2. Stress incontinence
3. Mixed incontinence (Urge + Stress)
4. Overflow incontinence

Question 4

What is overflow incontinence usually due to?

Answer 4

It is usually due to bladder outlet obstruction (e.g. due to prostate enlargement)

Question 5

What is usually the cause of urge incontinence?

Answer 5

Detrusor over activity

Question 6

What investigations should you do for incontinence?

Answer 6

1. Bladder diaries (website bladder matters)
2. Vaginal examination to exclude cystocele
3. Urine dipstick and culture
4. Residual volume scan USS - to exclude outflow obstruction

Question 7

How do you manage Urge incontinence

Answer 7

1. LIFESTYLE ADVISE - caffeine, manipulate fluid intake, weight loss.
2. BLADDER RETRAINING +/- pelvic floor exercises.
3. Antimuscarinics
   
   • FIRST LINE: Oxybutnin IM or Tolterodine IM or propiverine PO.
     
     • Start low dose and review at 4 weeks - increase as needed.
   • SECOND LINE: Solifenacin
4. Mirabegron (New medication)
5. Referral

Question 8

If antimuscarinics fail for urge incontinence, what medication can you trial?

Answer 8

Mirabegron

Mirabegron activates the β3 adrenergic receptor in the detrusor muscle in the bladder, which leads to muscle relaxation and an increase in bladder capacity.

Can cause high BP.

Question 9

What conditions would contraindicate the use of antimuscarinics?

Answer 9

• Closed angle glaucoma
• Myastenia gravis
• Severe UC
• Intestinal obstruction

Question 10

In urinary incontinence, what medication can you give for troubling nocturia?

Answer 10

Desmopressin

Question 11

If treatment for urge incontinence fails and you refer to secondary care, what might they do there?

Answer 11

Botox injections

Question 12

What is the management for stress incontinence?

Answer 12

1. Pelvic floor exercises - 8/3/3 (8 contractions, 3 times a day for 3 months)
2. If not improving refer to secondary care - will most likely require surgery (TVT etc)
3. Duloxetine - if wants to avoid surgery.

Question 13

What medication can you give someone with stress incontinence if they want to avoid surgery?

Answer 13

Duloxetine