9. Urinary incontinence

Question 1

Risk factors for UI

Answer 1

Women - pregnancy, child birth, menopause, pelvic surgery

Men - benign prostatic hyperplasia, prostate surgery

Non gender specific - smoking, obesity, constipation, stroke, parkinsons disease, dementia, depression

Question 2

Age related changes that increase risk of UI

Answer 2

• elastin reduces bladder capacity.
• delayed sensations from bladder
• decrease ability to postpone urination
• decreased flow rate
• decreased pelvic support muscle strength

Question 3

Types and characteristics of different types of UI (5)

Answer 3

Stress incontinence: involuntary leakage on effort or exertion (ie. coughing, straining, sneezing, lifting objects)

Urge urinary incontinence: involuntary leakage preceded by urgency which is difficult/impossible to defer

Overflow: now called chronic retention of urine, emptying failure by outlet obstruction or inability to contract detrusor (eg. Due to enlarged prostate, constipation, neurogenic bladder)

Functional incontinence: lack of recognition or ability to get to toilet in time (eg. Immobility, dementia)

Mixed incontinence: combination of the above types of UI

Question 4

Pharmacological management of Stress UI

Answer 4

Adrenergic agonists 	 
   o	Alpha adrenergic agonists 
        	Pseudoephedrine 
    o	Beta adrenergic agonists 
         	Terbutaline 

Duloxetine 	
     o	SNRI (serotonin norepinephrine reuptake inhibitor) antidepressant 

Oestrogens
o May improve or cure

Question 5

non-Pharmacological management of Stress UI

Answer 5

•	Review patients’ medications 
o	Some medications affect bladder control 
•	Alpha adrenergic blockers 
•	ACE inhibitors 
•	Pelvic floor exercises 
•	Treat constipation 
•	Treat chronic cough 
•	Weight loss

Question 6

non-Pharmacological management of Urge UI

Answer 6

• Boss of bladder - don’t go just in case
• Drink s6-9 glasses of water during the day and reduce bladder irritants such. As tea and. Coffee
• Avoid constipation
• Lose weight
• Exclude UTI

Question 7

Pharmacological management of Urge UI

Answer 7

= Anticholinergics
• Reduce involuntary detrusor contractions mediated by acetylcholine
• M3 receptors are main target
E.g Oxybutynin

Question 8

non-Pharmacological management of overflow UI

Answer 8

• Review medications
• If BPH is the cause- treat BPH
• Catheterisation
• Surgery e.g. TURP

Question 9

non-Pharmacological management of Functional incontinence

Answer 9

•	Loss of urine due to inability and unwillingness to go to toilet 
•	Associated with 
o	Immobility 
o	Loss of mental function 
•	Management 
o	Regular toileting assistance 
o	Pads

Question 10

Examples of drugs. that can adversely affect UI. (6)

Answer 10

• Oxybutynin (anticholinergic) causes urinary retention which can worsen overflow UI
• Amitriptyline (Anticholinergic) causes urinary retention
• Frusemide can worsen function UI as it increases frequency of urination, also may worsen overflow UI as it makes bladder full more often which increases risk of leakage
• Spironolactone increases amount of urine so worsens UI
• Perindopril may worsen/cause chronic cough (as do all ACE inhibitors) which may affect stress UI
• Paracetamol/codeine combination can cause constipation which increases pressure so worsens UI, and sedation which may worsen functional U

Question 11

How can nurses help with UI

Answer 11

• Primary health - access point of contact for advice
• Confidential/ empathy/ privacy
• Education/training
  * Fluid management
  * Timed voiding
  * Urge inhibition
  * Positive reinforcement
• Pelvic muscle training
• Review medications
• Referral to appropriate services
• Awareness of impact of the condition