What are the symptoms of storage incontinence?
Frequency
Urgency
Nocturia
What are the symptoms of voiding incontinence?
Hesitancy
Dribbling
Incomplete emptying
Intermittent stream
What is stress incontinence?
Weak pelvic floor/urinary outlet - bladder can’t store urine. Made worse with strain
What is urge incontinence?
High bladder pressure - bladder can’t store urine:
Overactive bladder (idiopathic) Neurogenic
What are the causes of voiding incontinence?
Bladder outlet obstruction:
Prostate enlargement
Constipation
Pelvic masses
What is functional incontinence?
Incontinence due to general impairment eg dementia, immobility
Lifestyle management of incontinence
Reduce alcohol/caffeine intake Lose weight Manage constipation Reduce fluid intake Stop smoking Incontinence products Referral to continence services
Management of stress incontinence
- Conservative:
Lifestyle
Pelvic floor exercises
Vaginal come - Surgical - mid urethral sling insertion
- Duloxetine BD (SEs: dry mouth, constipation, fatigue, nausea)
Management of urge incontinence
- Conservative
Lifestyle
Bladder training - Medical
- antimuscarinics (act on M3 in detrusor to reduce contraction) (SEs: dry mouth, constipation, fatigue, blurred vision)- Oxybutynin (not frail or PD)
- Tolteridone
- Darifenacin
- Intravaginal oestrogens
- Surgical - refer to urology
Management of BPH
Medical
- alpha blockers (tamulosin, doxazocin) reduce smooth muscle tone in prostate
- 5 alpha reductive inhibitors (finesteride) block conversion of testosterone to dihydrotestosterone, reducing prostate volume
Surgical
- Transurethral prostatectomy (TURP)
What drug would you give to treat nocturia if conservative measures fail?
Desmopressin - decreases the amount of urine produced
Antidiuretic, vasopressin analogue, increases aquaporin channels in collecting duct allowing increased water reabsorption.
What are the causes of urge incontinence?
Idiopathic - overactive bladder
Neurogenic - MS, PD, stoke, SC injury
Bladder outlet obstruction
UTI
