3.3: Urinary Incontinence

Question 1

What is urinary incontinence?

Common or rare?

Effect on QoL?

Answer 1

This is the complaint of the leakage of urine

Very common

Can affect QoL negatively - stigma, isolation, distressing, embarrassing

Question 2

Is urinary incontinence more common in women or men?

Answer 2

More common in women

Question 3

Name the urethral types of urinary incontinence?

Answer 3

Overflow Incontinence

Urge Incontinence

Stress Incontinence

Mixed Incontinence

Question 4

What route does urine usually leak via in urinary incontinence?

Describe two other ways it can leak?

Answer 4

Urethral Route

• Ectopic Ureter
• Fistula

Question 5

Describe the storage phase of micturition?

Answer 5

This is when the bladder stores the urine

• Afferent firing is low
• Sphincter and urethra contract
• Bladder relaxes (intravesical pressure is low)
• No flow of urine

Question 6

Describe the voiding phase of micturition?

Answer 6

• Afferent firing increases
• Detrusor muscle contracts (high intravesicular pressure)
• Sphincters and urethra relax
• Urine is passed

Question 7

Describe the intravesical pressure during storage as volume increases?

During voiding?

During coughing?

Answer 7

Intravesical pressure increases gradually during storage

Intravesical pressure increases, peaks then decreases during voiding

During coughing, there is sharp peaks in intravesical pressure

Question 8

Describe what happens to abdominal pressure on coughing?

Answer 8

Sharp peaks

Question 9

Describe what happens to detrusor pressure during storage?

During voiding

Answer 9

During storage, detrusor pressure increases

During voiding, it increases, peaks then decreases

Question 10

Describe the components of the micturition reflex?

Answer 10

Brain

Spinal Bladder Centre (S2, S3)

Bladder

Sphincters

Question 11

Describe the reflex arc of the bladder?

Answer 11

Afferent supplies the bladder

Efferent (in form of pudendal nerve) supplies the urethra and sphincters

Question 12

Describe overflow incontinence?

Answer 12

This is seen in chronic urinary retention due to outflow obstruction (unable to fully empty bladder)

There is a large palpable bladder

Insensible incontinence (Unaware of it, no control)

Often wet at night

Question 13

Describe urge incontinence?

Answer 13

Urgent desire to pass urine

Increased frequency - only small volumes

Can be provoked by standing up, coughing, laughing, sound of running water

Overactive bladder

Can causes enuresis (bed wetting)

Question 14

Urge incontinence may be due to ____ overactivity. Fill in the blank?

Characterized by?

Answer 14

Urge incontinence may be due to detrusor overactivity.

Characterized by detrusor muscle contractions during inhibition of voiding

Question 15

Describe the affect of afferent overstimulation on the bladder?

Answer 15

Can irritate the bladder

Can also cause urge incontinence

Question 16

Describe excess central faciliation?

Answer 16

This is caused by anxiety

Causes urge incontinence and increased frequency

Can be acute (before exams) or chronic (chronic anxiety)

Question 17

Describe the affect of paraplegia on the bladder?

Answer 17

There is loss of central inhibition

This results in loss of control over bladder voiding

Eg: Spinal Injury

Question 18

Describe what happens to the bladder if there is destruction of S2,S3 (Spinal Bladder Centre)

Answer 18

The bladder becomes an inert bag

Question 19

Describe what happens if there is pelvic fracture that damages the parasympathetic nerves?

Answer 19

The pudendal nerve is intact

There is residual urine and infection

Question 20

What happens in idiopathic detrusor overactivity?

Answer 20

May cause urge incontinence

Frequent urination of small volumes

There is a sudden urge to urinate which may be difficult to control

Nocturia (waking up to urinate)

Question 21

Describe stress incontinence?

Answer 21

Urine leaks during increased intrabdominal pressure without detrusor contraction

Can be due to pelvic floor damage or urethral dysfunction (Eg: Childbirth)

Question 22

Diagnosis of urinary incontinence?

Answer 22

Urinalysis

Abdominal Examination

Ultrasound of Bladder

Urodynamic Tests

Question 23

Treatment of overflow?

Answer 23

• Assess renal function
• Treat obstruction

(Catheter if needed)

Rehabilitate the bladder

Question 24

Treatment of urge urinary incontinence?

Answer 24

Avoid triggers (Caffeine)

Bladder Retraining

Medications: Antimuscarinics (Eg: Oxybutynin)

Beta 3 Adrenegics (Mirabegon)

Neuromodulation (Bladder pacemaker)

Surgery

Question 25

Treatment of stress incontinence?

Answer 25

Weight Loss

Smoking Cessation

Pelvic Floor Exercises

Surgical Correction

Question 26

Describe an ectopic ureter?

Answer 26

Very rare

Congenital

Causes urine to bypass the bladder and sphincters, leading to incontinence

Question 27

Describe a vesico-vaginal fistula?

Answer 27

Abnormal connection between vagina and bladder

Can cause incontinence

Common in developing countries due to prolonged time for labour

Question 28

Definition of stress urinary leakage?

Answer 28

Involuntary leakage on effort, exertion, sneezing or coughing

Question 29

Definition of urgency incontinence?

Answer 29

Involuntary leakage accompanied by or immediately preceeded by urgency

Question 30

Define Urgency?

Answer 30

Sudden compelling urge to pass urine

Difficult to inhibit

Question 31

Urgency (usually with or without urge incontinence) and with frequency and nocturia can be described as…?

Answer 31

Overactive Bladder