Urinary Incontinence

Question 1

Urinary incontinence Classification

Answer 1

1. Overactive bladder/urge incontinence: detressor overactivity
2. Stress incontinence: small amounts on raised IAP
3. Mixed: urge and stress
4. Overflow: outflow obstruction e.g. prostate?

Question 2

Urinary incontinence Ix

Answer 2

1. Bladder diary 3d minimum
   2.Vaginal examination:
   - exclude organ prolapse
   - examine pelvic floor strength
   - ask for cough to assess leakage
2. Dipstick and culture
   4, urodynamic testing if mixed incontinence

Question 3

Urge Incontinence Management

Answer 3

C: Acoid caffeine and artificial flavours
1st line: Bladder retraining 6wk (increase intervals)
2nd Line: Anrimuscarinic (oxybutinin or tolterodine)
3rd Line: Mirebegron (b3 agonist) - use if frail
4th Line: Surgery (botox, PTNS, SNS)

Question 4

Stress incontinence Mx

Answer 4

1st Line: Pelvic floor training (8 contraction TDS 3mo)
Adjunct - duloxtine (or pseudoephrine)
2nd Line: Surgery
 - retropubic mid urethral tape
 - Bulking (inj. to sphincter)
 - Autologous fascial sling
- Burch coloposupsension

Question 5

PACES couselling Incontience

Answer 5

RF: - Stress: age, trauma, obesity
      - Urge: age, obesity, smoking, FHx, DM
Explain: mechanism
Lifestyle advice (wt, caffience)
Mx:
- Urge: 6wk retraining
- Stress: pelvic floor 3mo
Discuss if fail then medical/surgical options