Urinary Incontinence

Question 1

What is stress incontinence?

Answer 1

Involuntary, spontaneous urine loss that occurs with strenuous physical activity

Question 2

What is urgency incontience?

Answer 2

Involuntary, spontaneous urine loss that occurs with an uncontrollable sense of urgency

Question 3

What is mixed incontinence?

Answer 3

urgency and stress

Question 4

What can urinary incontience be caused by?

Answer 4

alterations in anatomical support and/or neuromuscular function of the pelvic floor, or may be idiopathic

Question 5

What is epid of UI?

Answer 5

1. puerperal period

2. older and obese women with neurological conditions.

Question 6

What are RF for urinary incontinence?

Answer 6

1. Increasing age
2. Pregnancy
3. Obesity
4. Lower UTI
5. Dementia
6. Constipation
7. Stroke
8. Parkinson’s disease

Question 7

What is the presentation of urinary incontience?

Answer 7

1. Involuntary urine leakage on effort, exertion, sneezing or coughing
2. Involuntary urine leakage accompanied by or immediately preceded by urgency
3. Frequency of urination
4. Suggestive bladder diary
5. Vaginal bulge/pressure
6. Urogenital atrophy

Question 8

What are Ix for urinary incontinence?

Answer 8

1. Empty supine stress test
2. Urinalysis
3. Post-void residual measurement
4. Cough stress test

Question 9

What is management for urinary incontinence?

Answer 9

1st line: behavioural approaches plus lifestyle changes

Pharmacotherapy

Question 10

When do you refer urgently (within 2 weeks) using a suspected cancer pathway referral for bladder cancer if the woman?

Answer 10

1. Is aged 45 years and over with:
   - Unexplained visible haematuria without urinary tract infection, or
   - Visible haematuria that is persistent or recurrent after successful treatment of urinary tract infection, or
2. Is aged 60 and over with unexplained non-visible haematuria and dysuria or a raised white cell count on a blood test.

Question 11

What is a common cause of incontinence in men?

Answer 11

1. Enlarged Prostate

2. TURP and other pelvic surgery can weaken bladder sphincter

Question 12

What is urge incontinence due to?

Answer 12

detrusor overactivity

Question 13

What are other causes of urinary incontinence in men?

Answer 13

1. Detrusor overactivity
2. Primary bladder neck obstruction
3. Urethral stricture

Question 14

What is 1st line treatment in stress incontinence?

Answer 14

pelvic floor exercises

Question 15

What other management can be used in stress incontinence?

Answer 15

• Ring pessary can help uterine prolapse
• Intravaginal electrical stimulation
• Surgery: e.g. tension free vaginal tape
• medicine

Question 16

What medicine can be used in stress incontinence?

Answer 16

Duloxetine 40mg/12h PO (SE: nausea)

Question 17

What is the management of urge incontinence?

Answer 17

• 3 day diary
• Examine for spinal cord and CNS signs
• Vaginitis (postmenopausal) – topical oestrogen therapy
• Weight loss and pelvic floor exercises

Question 18

What medicine is used in urge incontinence?

Answer 18

1. Antimuscarcinic agents

2. Beta 3 adrenergic agonist

Question 19

What must be done before surgery?

Answer 19

urodynamic assessment to exclude detrusor overactivity or sphincter dyssynergia