Urinary Incontinence

Question 1

What is Urinary Incontinence?

Answer 1

Involuntary leakage of urine

Question 2

What are the 2 types of Urinary Incontinence?

Answer 2

1. Urge
2. Stress

Question 3

What is Mixed Incontinence?

Answer 3

Pt with features of both types of incontinence (most common)

Question 4

What is the definition of Stress Incontinence?

Answer 4

Involuntary urine leakage @ increased intra-abd pressure

Question 5

When is Stress Incontinence typically seen?

Answer 5

After childbirth (aka most common causative factor)

Question 6

What is Stress Incontinence due to?

Answer 6

Weakness of pelvic floor + sphincter muscles

Question 7

What occasions does urine leak out with Stress Incontinence? (4 things)

Answer 7

1. Laughing
2. Coughing
3. Sneezing
4. Surprised

Question 8

What is Urge incontinence caused by?

Answer 8

Overactivity of detrusor muscle

Question 9

What is another name for Urge incontinence?

Answer 9

Overactive bladder

Question 10

What are the RF for Urinary Incontinence? (8 things)

Answer 10

1. Age
2. BMI
3. Postmenopausal
4. Vaginal delivery
5. Pelvic organ prolapse
6. Pelvic floor surgery
7. Neurological conditions (e.g MS)
8. Cogn impairment / Dementia

Question 11

What are the CF of Stress Incontinence? (3 things)

Answer 11

1. Leakage @ exertion (ask pt to cough)
2. SMALL volume leakage
3. Prolapse of urethra + ant vaginal wall (@ exam)

Question 12

What are the CF of Urge Incontinence? (4 things)

Answer 12

1. Urgency
2. Frequency
3. Nocturia
4. LARGE volume leakage

Question 13

What are some triggers for urgency in Urge Incontinence? (2 things)

Answer 13

1. Hearing running water
2. Cold weather

Question 14

What is the aim of the primary investigation for sus Incontinence?

Answer 14

Excluding UTI

Question 15

What are the 2 main investigations for Incontinence?

Answer 15

1. Frequency / volume charts
2. Urodynamic studies

Question 16

How do you distinguish between Stress vs Urge with Frequency / volume charts?

Answer 16

• Stress = Normal frequency
• Urge = Increased frequency

Question 17

What is the point of doing Urodynamic Studies? (2 points)

Answer 17

1. Done for Stress incontinence when considering surgery
2. Used to confirm Dx + rule out detrusor over-activity

Question 18

What is important a pt does before Urodynamic Studies are done?

Answer 18

Stop taking anticholinergic meds 5 days before

Question 19

What are some important Modifiable lifestyle factors you should ask about in the Hx of sus Incontinence? (3 things)

Answer 19

1. Caffeine / Alcohol consumption
2. Meds
3. BMI

Question 20

What are you checking for @ examination of sus Incontinence? (5 things)

Answer 20

1. Pelvic tone
2. Pelvic organ prolapse
3. Atrophic vaginitis
4. Urethral diverticulum
5. Pelvic mass

Question 21

What are the CONSERVATIVE Mx options for Stress Incontinence? (4 things)

Answer 21

1. X caffeine / alcohol / overfilling bladder
2. Weight Loss
3. TUC (e.g chronic cough)
4. Pelvic floor exercises (supervised)

Question 22

How long should Pelvic floor exercises be done for before considering Surgery?

Answer 22

3 months

Question 23

What are the SURGICAL Mx options for Stress Incontinence? (2 things)

Answer 23

1. Tension Free Vaginal Tape (TVT) (most common)
2. Laparoscopic colposuspension

Question 24

What does Tension Free Vaginal Tape (TVT) involve?

Answer 24

Tape placed under mid-urethra via small vaginal incision

Question 25

When should someone have MEDICAL Mx for Stress Incontinence?

Answer 25

Woman doesn’t want / not suitable for surgery

Question 26

What is the Medical Mx of Stress Incontinence?

Answer 26

Duloxetine (SNRI antidepressant)

Question 27

What are the CONSERVATIVE Mx options for Urge Incontinence? (2 things)

Answer 27

1. X caffeine / alcohol / overfilling bladder 2. Bladder retraining

Question 28

What are the MEDICAL Mx options for Urge Incontinence? (2 things)

Answer 28

1. Anticholinergics (e.g oxybutynin) 2. Mirabegron (alternative to anticholinergics)

Question 29

What are the Side fx of using Anticholinergics for Urge Incontinence? (5 things)

Answer 29

1. Confusion 2. Dry eyes / mouth 3. Blurred vision 4. Arrhythmias 5. Constipation

Question 30

What are the CI for taking Anticholinergics for Urge Incontinence? (3 things)

Answer 30

1. Acute angle glaucoma 2. Myasthenia gravis 3. GI obst

Question 31

What are the CI for taking Mirabegron for Urge Incontinence?

Answer 31

Uncontrolled HTN

Question 32

Who is SURGICAL Mx of Urge Incontinence reserved for?

Answer 32

Only those with debilitating symptoms

Question 33

What is the SURGICAL Mx option for Urge Incontinence?

Answer 33

Detrusor myomectomy + Augmentation Cystoplasty (using bowel tissue to enlarge bladder)

Question 34

Which Incontinence type is SURGICAL BEFORE MEDICAL Mx?

Answer 34

Stress Incontinence (doc gets STRESSED n instantly does da Surgery)