Urinary incontinence

Question 1

What are the types of urinary incontinence

Answer 1

Urge incontinence
Stress incontinence

Question 2

What is urge incontinence

Answer 2

Overactivity of the detrusor muscle of the bladder

Question 3

How does urge incontinence present

Answer 3

Sudden urge to pass urine, rush to bathroom, not neccessaruly in time
Conscioious about toilet being available at all times

Question 4

What is stress incontinence

Answer 4

Weak pelvic floor muscles and sphincter muscles - urine leaks when increased pressure on bladder eg laugh, cough

Question 5

What is mixed incontinence

Answer 5

urge incontinence and stress incontinence

Question 6

What is overflow incontinence and who is it more common in

Answer 6

Chronic urinary retention due to obstruction of flow of urine, incontinence without urge to pass urine
More common in men

Question 7

What can cause overflow incontinence

Answer 7

Anticholinergics
Fibroids
Pelvic tumours
Nuerological conditions eg MS neuropathy, spinal cord injuries

Question 8

Risk factors for urinary inctoninence

Answer 8

Increased age
Postmenopausal status
Increased BMI
Prev pregnancies and vaginal deliveries
Pelvic organ prolapse
Pelvic floor surgery
Neurological conditions eg MS
Cognitive impairment and dementia

Question 9

What should be done if women present with overflow incontinence

Answer 9

Referred for urodynamic testing and specialist management

Question 10

What modifiable risk factors can contribute to incontince

Answer 10

Caffeine
Alcohol
Medications
BMI

Question 11

Severity incontinence questions to ask

Answer 11

Frequency urination
Frequency incontinence
Nighttime urination
Ue of pads and changes of clothing

Question 12

What should examination for urinary incontinence assess

Answer 12

Pelvic tone and examine for:
Pelvic organ prolapse
Atrophic vaginitis
Urethral diverticulum
pelvic masses
Ask patient to ocugh and watch for leakage

Question 13

How assess pelvic muscle contractions

Answer 13

Bimanual examination
Ask woman to squeeze against fingers

Question 14

How grade pelvic muscle contractions

Answer 14

0 - no contraction
1 - faint contraction
2 - weak contraction
3 - moderate contraction with some resistnace
4 - good contraction with resistance
5 - strong contraction a firmsqueeze, drawing inwards

Question 15

Investigations for incontinence

Answer 15

Bladder diary completed
Urine dipstick
Post void residual bladder volume (bladder scan)
Urodynamic testing

Question 16

wHY DO URINE dipstick in urine incontinence

Answer 16

assess infection, microscopic haematuria and other path

Question 17

What does a bladder diary contain

Answer 17

should be completed, tracking fluid intake and episodes of urination and incontinence over at least three days. There should be a mix of work and leisure days.

Question 18

What is urodynamic testing used to investigate

Answer 18

Urge incontinence that isnt responding to first line medical treatments, difficulties urinating, urinary retention, prev surgery or unclear diagnosis

Question 19

What do patients need to do 5 days before urodynamic test

Answer 19

Stop taking anticholinergic and bladder related medications around five days before tests

Question 19

What do patients need to do 5 days before urodynamic test

Answer 19

Stop taking anticholinergic and bladder related medications around five days before tests

Question 20

How is a urodynamic test carried out

Answer 20

Thin catheter inserted into bladder, another into rectum. Used to measure differences in pressure to compare

Question 21

What outcomes are measured in urodynamic testing

Answer 21

Cystometry
Uroflowmetry
Leak point pressure
Post void residual bladder volume
Video urodynamic testing - only when necessary, not routine

Question 22

What does cystometry measure

Answer 22

Detrusor muscle contraction and pressure

Question 23

What does uroflowmetry and post void residual bladder volume measure for

Answer 23

Flow rate
Incompltete emptying of bladder

Question 24

What is leak point pressure

Answer 24

point at which bladder pressure results in leakage of urine Patient asked to cough, move or jump when bladder filled to various capacities Assess for stress incontinence

Question 25

What does video urodynamic testing test for

Answer 25

Contrast and taking x ray images as bladder emptied. not routine

Question 26

Management of stress incontinence

Answer 26

Avoid caffeine, diuretics and overfilling bladder Avoid excessive or restricted fluid intake Weight loss (if appropriate) Supervised pelvic floor exercises Surgery Duloxetine - SNRI second line where surgery less preferred

Question 27

What need to do before will consider surgery for incontinence

Answer 27

for at least three months before considering surgery

Question 28

What do for pelvic floor exercises

Answer 28

at least 8 contractions, 3 x daily

Question 29

What are the surgical options for incontinence

Answer 29

Tension-free vaginal tape Autologous sling procedures Colpsuspension Intramural urethral bulking

Question 30

What is TVT

Answer 30

procedures involve a mesh sling looped under the urethra and up behind the pubic symphysis to the abdominal wall. This supports the urethra, reducing stress incontinence.

Question 31

Autologous sling procedures

Answer 31

work similarly to TVT procedures but a strip of fascia from the patient’s abdominal wall is used rather than tape

Question 32

What is colposuspension

Answer 32

Stitches connecting anterior vaginal wall forwards and adding support to the urethra

Question 33

What is intramural urethral bulking

Answer 33

Involves injections around urethra to reduce diameter and add support

Question 34

What cna do if stress incontinence cuased by neurorological disorder

Answer 34

Artificial urinary sphincter pump inserted labia inflates deflates cuff around urethra, allowing women to control continence manually

Question 35

Management of urge incontinence

Answer 35

Bladder retraining = for at least 6 weeks = first line Anticholinergic medication Mirabegron Invasive procedures - medical treatment fialed

Question 36

Example of anticholinergics used for incontinence

Answer 36

Oxybutinin, tolterodine and solifenacin

Question 37

Anticholinergic side effects, why especially difficult in older patients

Answer 37

Dyr mouth, eyes, urinary retention, constipation and postural hypertension Can lead to cognitive decline, memory problems and worsening dementia

Question 38

What is mirabegon contraindicated in

Answer 38

Uncontrolled HPTN BP monitored refuarlty

Question 39

How can mirabegon lead to stroke

Answer 39

Beta 3 agnoitst, stimulating sympathetic nervous system -> raised BP -> hypertensive crisis, increased risk TIA and stroke

Question 40

What are invasice options for overactive bladder failed repsonse medicine

Answer 40

Botulinum toxin tyoe A injection into bladder wall Percutaneous sacral nerve stimulation Augmentation cystoplasty - bowerl tissue enlarge bladder Urinary diversion - redirect to urostomy in abdomen