Incontinence

Question 1

What are the 6 main types of incontience

Answer 1

Stress -> incontinence due to an increased intra-abdominal pressure

Urge -> sudden urge to pass urine due to overactivity of the detrussor muscle

Overflow -> urine retention due to an incompatipility for complete voiding

Neurogenic -> incontinence due to a decreased nerve sensitivity controlling urination

Post-coital -> incontinence after penetration or orgasm

Mixed -> just a wee mix of all types of incontinence

Question 2

What treatment should always be done for incontinence

Answer 2

Pelvic floor fucking exercises

Question 3

What type of incontinence is duloxetine used to treat

Answer 3

Stress

Question 4

What type of incontience is Trans-cutaneous Electrical Nerve Stimulation (TENS) used to treat

Answer 4

Overflow

Question 5

What type of incontinence is neuromodulation used to treat

Answer 5

Neurogenic

Question 6

What type of incontinence can be caused by prolonged catheterisation and therfore treated by removing said cathater

Answer 6

Neurogenic

Question 7

Why can coughing, sneezing and moving cause stress incontinence

Answer 7

As they all cause an increased intra-abdominal pressure

Question 8

What type of drug is duloxetine

Answer 8

Serotonin and Norepinephrine Reuptake Inhibitor (SNRI)

Question 9

Women who have had several pregnancies are at an increased risk of what type of incontinence

Answer 9

Stress incontinence

Question 10

Which type of incontinence have patients that ‘know where every public toliet is’

Answer 10

Urge

Question 11

What type of incontinence is due to involuntary contractions of the detrussor muscle

Answer 11

Urge

Question 12

What type of incontinence can also cause urine retention and why

Answer 12

Overflow

The urethra is blocked so you can’t fully voi

Question 13

What type of incontinence can be caused by benign prostate hyperplasia (BPH) and how can it be treated

Answer 13

Type of incontince -> overflow

Treated with -> Trans urethral resection of the porstate (TURP) & a-blockers

Question 14

What are some of the causes of neurogenic incontinence

Answer 14

Prolonged cathertisation

Neurological disease (e.g. stroke or MS)

Question 15

What is a way of indicating the severity of incontinence

Answer 15

How many pads the woman gets through

Question 16

Urine incontinence can occur during the night, what is the definition of nocturia

Answer 16

Waking up on more than 1 occasion to piss

Question 17

What type of incontience can cause recurrent UTIs and why

Answer 17

Overflow incontinence

Due to urine retention

Question 18

What is the 1st line investigation that you should get all patients who complaining of incontience to kick-off with

Answer 18

3-day urine diary

Question 19

What investigation shoudl you do if haematuria occurs

Answer 19

Cystoscopy

Question 20

What are the investigations for incontinence

Answer 20

3-day urine diary

Abdominal & pevlic exam

Urinalysis

Mid-stream sample of urine (MSSU)

Cystosocpy

Urodynamics

Question 21

What are some of the risk factors for incontinence

Answer 21

Being a woman

High parity

Heavy baby

Induced pregnancy

Old age

Obesity

Pelvic floor trauma

Smoking

Environment

Question 22

What environment can increase your risk of incontinence

Answer 22

Being in hopsital

Question 23

If a patient with incontience is obese and has a BMI of over 35, what treatments can you not undergo

Answer 23

Surgery

Question 24

What methods of induced labour increases your risk of incontinve

Answer 24

Forceps delivery

Vaccuum extraction

Question 25

What sex is most likely to suffer from incontience

Answer 25

Females bruh

Question 26

What is the 1st line treatment for incontinence and for how long should they be used for

Answer 26

Pelvic floor exercises Used for 3 months

Question 27

What are some of the causes of incontinence

Answer 27

Stressful lifestyle Pelvic trauma Detrussor degeneration (old age) Diuretics Drinking too much BPH Defect in vesico-ureteric valve

Question 28

What medication shoudl you always check that patients with incontinence are on as they may be the cause of it

Answer 28

Diuretics

Question 29

What is a very common reason for incontinence that should be discussed with the patient

Answer 29

Drinking too much

Question 30

In a history, what should you discuss with patients with incontinence

Answer 30

Age Parity Mode of deliverly (e.g. foreceps) Weight of heaviest baby Smoking history HRT PMH

Question 31

What questions should you ask in a patient's PMH about incontinence

Answer 31

Diabetes (can cause a big baby that damages the pelvic floor) Cardio/liver/renal problems Hypertension Glaucoma

Question 32

Why must you ask if patient's with incontinence have/had glaucoma

Answer 32

As they wont be able to be treated with anti-cholinergics

Question 33

What are the treatments for incontinence

Answer 33

Lifestyle changes Pelvic floor exercises Vaginal cones a-/B-adrenoreceptor agonists Anti-cholinergics Anti-musacrinics Surgery

Question 34

How do anti-cholinegrics treat incontinence

Answer 34

Blocks the action of ACh Decreases sympathetics tone Increases parasympathetic tone

Question 35

Which drugs treat incontince by increasing sympathetic tone

Answer 35

a-adrenorectpor agonsits B-adrenoreceptor agonists Anti-muscarinicns

Question 36

When would you use B-adrenoreceptor agonists to treat incontinence

Answer 36

When anti-muscarinics can't be used

Question 37

What surgical treatments are used for incontinence

Answer 37

Burch Colposuspension Cathaterisation Trans-vaginal tape

Question 38

What is the name of the CNS centre that controls urination

Answer 38

Pontine micturation centre

Question 39

What 2 nerves control the parasymapthetic innervation for urination

Answer 39

Pelvic nerve Pudendal nerve

Question 40

What spinal nerves provide parasympathetic innervatoin for urination

Answer 40

S2-S4

Question 41

What 2 type of nerves provide sympathetic innervation for urination and what spinal levels are the following nerve

Answer 41

B-adrenoreceptors -\> T10-L2 a-adrenoreceptors -\> T10-S2

Question 42

What nervous system controls the external urethral sphincter and therefore provides voluntary control over urination

Answer 42

Somatic nervous system

Question 43

What are the 3 requirements for urination to occur

Answer 43

Involuntary relaxatoin of internal urethral sphincter Involuntary contraction of bladder Voluntary relaxation of external urethral sphincter

Question 44

What is the normal bladder capcaity

Answer 44

400-600ml

Question 45

After what volume of urine in the bladder causes you to: a) feel like you need to pee b) desperate to pee

Answer 45

a) 250ml b) 500ml