what is urinary incontinence?
involuntary loss of urine
what changes occur to the urinary system with ageing?
decreased bladder capacity and urethral closure pressure
increased post void residual volume and detrusor overactivity
name the transient causes of incontinence
mnemonic = DIAPERS
delirium infection atrophic urethritis/vaginitis pharmaceutical/prostate psychological endocrine restricted mobility stool impaction
what are the five types of incontinence?
stress urge mixed overflow functional
what is stress incontinence?
involuntary leakage on effort or exertion
what is urge incontinence?
involuntary leakage accompanied by or immediately preceded by urgency
what is mixed incontinence?
involuntary leakage associated with urgency and also exertion
what is overflow incontinence?
leakage owing to bladder outflow obstruction of any cause, resulting in large post void residual volume
what is functional incontinence?
incontinence due to inability to reach/use the toilet in time
what investigations are done for incontinence?
post void bladder scan
bladder diaries
bloods
urodynamic studies (complex cases)
what bloods should be considered in incontinence?
PSA
U+E’s
glucose
what lifestyle changes can help incontinence?
reduced caffeine intake
weight loss
what physical things can be done to manage incontinence?
pelvic floor exercises
bladder training
exercise
when is pharmacological management of incontinence started?
3 months of non-pharmacological management failed
what is the first line pharmacological management of incontinence?
tolterodine 2mg daily
what is the second line pharmacological management of incontinence?
solifenacin 5mg once daily
no response after six weeks = increase to 10mg once daily
what is the third line pharmacological management of incontinence?
mirabegron MR 50mg once daily
what needs to be done when starting a patient on mirabegron for incontinence?
monitor BP before initiation, one month after and then at least annually
what medication can be given for nocturia?
late afternoon diuretic
desmopressin
