Incontinence

Question 1

What are the categories of urinary incontinence?

Answer 1

Stress incontinence, Urge incontinence, Overflow incontinence, Functional incontinence, Mixed incontinence

Question 2

What does the mnemonic ‘DIAPPERS’ stand for in relation to reversible causes of urinary incontinence?

Answer 2

• D - Delirium
• I - Infection
• A - Atrophic vaginitis or urethritis
• P - Pharmaceutical (medications)
• P - Psychiatric disorders
• E - Endocrine disorders (e.g. diabetes)
• R - Restricted mobility
• S - Stool impaction

Question 3

What is stress incontinence?

Answer 3

Leaking of urine when intra-abdominal pressure is raised, overcoming mechanisms designed to maintain continence.

Question 4

What are the risk factors for stress incontinence?

Answer 4

• Childbirth (especially vaginal)
• Hysterectomy

Question 5

What triggers stress incontinence?

Answer 5

Acts such as coughing, laughing, sneezing or exercising.

Question 6

What causes stress incontinence?

Answer 6

Any abnormality in the anatomy of the bladder, sphincters, and urethra.

Question 7

What are the conservative management strategies for stress incontinence?

Answer 7

• Avoiding caffeine, fizzy and sugary drinks
• Avoiding excessive fluid intake
• Pelvic floor exercises

Question 8

What is the role of Duloxetine in stress incontinence?

Answer 8

Helps with stress incontinence but only if conservative measures fail and the patient is not a surgical candidate.

Question 9

What is the purpose of incontinence pessaries?

Answer 9

Placed transvaginally to apply pressure to the anterior vaginal wall and support the urethra and sphincters.

Question 10

What are bulking agents used for in stress incontinence?

Answer 10

Injectable materials placed at the bladder neck to improve continence.

Question 11

What is colposuspension?

Answer 11

Surgical method involving suspending the anterior vaginal wall to the iliopectineal ligament of Cooper.

Question 12

What is the gold standard surgical treatment for stress incontinence?

Answer 12

Mid-urethral slings.

Question 13

What is urge incontinence?

Answer 13

The sudden and involuntary loss of urine associated with urgency.

Question 14

What are the risk factors for urge incontinence?

Answer 14

• Recurrent urinary tract infections
• High BMI
• Advancing age
• Smoking
• Caffeine

Question 15

What conservative management strategies can help with urge incontinence?

Answer 15

• Avoiding caffeine, fizzy and sugary drinks
• Avoiding excessive fluid intake
• Pelvic floor exercises
• Bladder training

Question 16

What role do anticholinergic medications play in urge incontinence?

Answer 16

Help reduce symptoms by inhibiting parasympathetic action on the detrusor muscle.

Question 17

Give examples of anticholinergic medications.

Answer 17

• Oxybutynin
• Tolterodine
• Fesoterodine
• Solifenacin

Question 18

What is the purpose of Mirabegron in urge incontinence?

Answer 18

A beta-3 receptor agonist used with caution in older patients.

Question 19

What is bladder instillation?

Answer 19

Intravesical injection of Botox to paralyze the detrusor muscle.

Question 20

What is sacral neuromodulation?

Answer 20

Sacral nerve stimulation to control symptoms of an overactive bladder.

Question 21

What is functional incontinence?

Answer 21

Inability to access necessary facilities to pass urine, leading to incontinence.

Question 22

What causes functional incontinence?

Answer 22

• Sedating medications
• Alcohol
• Dementias

Question 23

What is first lien for stress incontinence?

Answer 23

Pelvic floor exercises

Question 24

What is first line for urge incontinence?

Answer 24

Bladder training

Question 25

What increases the risk of neurogenic incontinence?

Answer 25

Diabetes

Question 26

What increases the risk of overflow incontinence?

Answer 26

Chronic urinary retention from the use of anti cholinergic like amitriptylline