10: Urinary incontinence

Question 1

What is incontinence?

Answer 1

Involuntary leakage of urine

Question 2

Incontinence is very ___ for the patient.

Answer 2

embarrassing

Question 3

Incontinence is more common in (men / women).

Answer 3

women

Question 4

Why is incontinence more common in women?

Answer 4

They only have one urethral sphincter so rely on pelvic floor

Men have two

Question 5

In micturition, the internal urethral orifice ___ and the bladder ___.

Answer 5

relaxes

contracts

Question 6

During filling, the bladder muscle ___.

During voiding, the bladder muscle ___.

Answer 6

relaxes

contracts

Question 7

What two structures fail to cause incontinence?

Answer 7

Either a

sphincter problem

overactive bladder muscle problem

Question 8

Which receptors detect the filling of the bladder?

Answer 8

Stretch receptors

Question 9

Which spinal nerves control the micturition reflex?

Answer 9

S2,3,4

Question 10

What neuro mechanisms control

a) involuntary voiding
b) voluntary inhibition of voiding?

Answer 10

a) Micturition reflex (parasympathetics of S2,3,4)
b) Pons

Question 11

What urinary problems occur in

a) CNS problems e.g Parkinson’s
b) severed spinal cord?
c) problems with the sacral spinal nerves?

Answer 11

a) Micturition reflex persists, so incontinence

b) Detrusor sphincter dyssnergia

c) Retention

Question 12

What is urge incontinence?

Answer 12

Incontinence preceded by URGENCY

i.e desire to void

Question 13

What is stress incontinence?

Answer 13

Involuntary voiding due to raised IAP e.g in coughing, laughing

Question 14

What is overflow incontinence?

Answer 14

Involuntary urination associated with obstruction

Question 15

What are types of incontinence causing

a) bedwetting
b) terminal dribble?

Answer 15

a) Nocturnal enuresis

b) Post-micturition dribble

Question 16

Which neuro disorders increase your chances of incontinence?

Answer 16

Parkinson’s

MS

Stroke

Question 17

What are some anatomical causes of incontinence?

Answer 17

Ectopic ureters

Fistulas

Traumatic childbirth

Question 18

Why does smoking cause incontinence?

Answer 18

Cough

Question 19

Why can obesity cause incontinence?

Answer 19

Weakened pelvic floor muscles

Question 20

Which drugs can cause urinary incontinence?

Answer 20

Alpha blockers

cause ureteric relaxation

Question 21

What are some important questions to ask in the history of someone with incontinence?

Answer 21

How often?

Volume?

When (day / night)?

ICE

Question 22

What examinations are done for someone with incontinence?

Answer 22

Abdominal exam

PR exam

PV exam

Question 23

What should be checked on PR exam of someone with urine obstruction?

Answer 23

Prostate gland

Anal tone

Question 24

Which investigation measures urine flow?

Answer 24

Uroflowmetry

Question 25

What does a **slow urine flow rate** indicate?

Answer 25

**Obstruction** **Weak detrusor muscle**

Question 26

Why do **women** have a faster flow rate than men?

Answer 26

**Shorter urethra** Less resistance Higher pressure

Question 27

What can a patient keep to track their urinary symptoms?

Answer 27

**Diary**

Question 28

What investigation allows you to view the anatomy of the bladder?

Answer 28

**Cystoscopy** for stricture, stone, tumour, fistula

Question 29

What scan would be used to check the kidneys in the case of hydronephrosis secondary to obstruction?

Answer 29

**USS kidneys**

Question 30

Anything which increases ____ pressure can cause **stress incontinence**.

Answer 30

**intra-abdominal pressure**

Question 31

What causes **stress incontinence**?

Answer 31

**Weak pelvic floor muscles** **Weak sphincters**

Question 32

How is **stress incontinence** managed?

Answer 32

**Lifestyle** - avoid caffeine, stop smoking, optimise respiratory treatments, lose weight **Pelvic floor exercises** **Duloxetine** - rarely used drug which causes smooth muscle contraction **Surgery** - narrowing of bladder neck

Question 33

Which symptom is associated with **urge** incontinence? What causes it?

Answer 33

**Urgency** **Overactive bladder**

Question 34

Apart from **urgency**, what symptoms are seen in **urge incontinence**?

Answer 34

**Increased frequency** **Nocturia**

Question 35

**Urge incontinence** is associated with a ___ bladder.

Answer 35

**overactive**

Question 36

What should always be asked about when taking a **fluid** history from patients?

Answer 36

**Water** **Coffee/Tea** **Alcohol**

Question 37

How is **urge incontinence** managed?

Answer 37

**Lifestyle management** - fluid restriction, coffee, alcohol **Bladder training** **Oxybutynin** or **tolterodine** - anticholinergic, relaxes bladder smooth muscles **Surgery**

Question 38

What type of incontinence is associated with **obstruction**?

Answer 38

**Overflow incontinence**

Question 39

What is the presenting symptom of **chronic retention**?

Answer 39

**Painless abdominal mass** **Reduced frequency** **Nocturia** **Potentially haematuria due to AKI**

Question 40

How is **overflow incontinence** managed?

Answer 40

**ADMIT:** Catheterise Check renal function Surgery

Question 41

What is an **anatomical** problem of the vagina which causes incontinence?

Answer 41

**Vesicovaginal fistula**