incontinence

Question 1

supply of detrusor and para or symp?

Answer 1

parasympathetic S2,3,4

Question 2

what supplys the urethral smooth muscle? symp or para

Answer 2

sympathetic T10- L2

Question 3

what is stress incontinence

Answer 3

leakage of urine when increased abdo pressure

Question 4

does the detrusor contract in stress incontinence

Answer 4

no

Question 5

when is stress incontinence seen

Answer 5

after childbirth, pelvic surgery, oestrogen deficiency

Question 6

triggers for stress incontinence

Answer 6

coughing , sneezing , exercise

Question 7

what shoudl be excluded when investigating stress incontinence

Answer 7

UTI

Question 8

investigations for stress incontinence

Answer 8

frequency/vol charts done- should show norm results

Question 9

management of stress incontinence- conservative

Answer 9

wgt loss, smoking cessation, avoid constipation, avoid heavy lifting and caffeine
then pelvic floor exercises for 3 months

Question 10

management of stress incontinence - medical

Answer 10

duloxetine (side effects counselling) or vaginal oestrogen
surgery - bulking agents
fascial sling
colposuspension

Question 11

describe urge incontinence

Answer 11

overactive bladder - increased. urgency and frequency may experience nocturia

Question 12

triggers for urge incontinence

Answer 12

hearing water and cold weather

Question 13

what produces larger volumes stress or urge incontinence

Answer 13

urge

Question 14

causes of urge incontinence

Answer 14

idiopathic, pelvic surgery, MS , spina bifida

Question 15

Investigatiosn of urge incontinence

Answer 15

fre/vol charts show increased frequency

urodynamics show increased detrusor activity

Question 16

management of urge incontinence - conservative

Answer 16

lifestyle - reduce fluids, minimise caffeine adn alcohol, pads
bladder retraining

Question 17

management of urge incontinence - medical

Answer 17

oxybutynin - anti cholinergic 
mirabegron - b3 agonist
intravaginal OE
consider desmopressin if nocturia 
suregry - botox, sacrak nerve stim

Question 18

why might oxybutynin be avoided in elderly ahd what shoudl be used instead

Answer 18

can casue confusion, tolterodine or solifenanic

mirabegron

Question 19

what is overflow incontinence

Answer 19

leakage of urine from full bladder as no urge to go

Question 20

causes of overflow incontinence

Answer 20

inactive detrusor eg MS

involuntary bladder spasm eg CV or diabetes

Question 21

what should you give to a pregnant women with a UTI in 1st /2nd and 3rd trimester. does a urine culture need to be done

Answer 21

1st and 2nd - nitrofurantoin
3rd - trimethoprime

yes if pregnant , >65 or haematuria