Urinary incontinence

Question 1

Risk factors

Answer 1

advancing age
previous pregnancy and childbirth
high body mass index
hysterectomy
family history

Question 2

Classification Urinary incontinence

Answer 2

1) overactive bladder (OAB)/urge incontinence
- detrusor overactivity
-urge to urinate is quickly followed by uncontrollable leakage ranging from a few drops to complete bladder emptying

stress incontinence: leaking small amounts when coughing or laughing

mixed incontinence: both urge and stress
overflow incontinence: due to bladder outlet obstruction, e.g. due to prostate enlargement

overflow incontinence: due to bladder outlet obstruction, e.g. due to prostate enlargement

functional incontinence
comorbid physical conditions impair the patient’s ability to get to a bathroom in time
causes include dementia, sedating medication and injury/illness resulting in decreased ambulation

Question 3

If urge incontinence is predominant Mx:

Answer 3

bladder retraining (lasts for a minimum of 6 weeks - increase intervals before voiding)

bladder stabilising drugs: antimuscarinics are first-line
- oxybutynin (immediate release),
- tolterodine (immediate release)
- darifenacin (once daily preparation)

Question 4

Immediate release oxybutynin should, however, be avoided in ?

Answer 4

frail older women’

Question 5

frail older women should have ?

Answer 5

mirabegron (a beta-3 agonist) - if there is concern about anticholinergic side-effects in frail elderly patients

Question 6

stress incontinence is predominant Mx?

Answer 6

pelvic floor muscle training
minimum of 3 months

surgical procedures: e.g. retropubic mid-urethral tape procedures

Question 7

women if they decline surgical procedures stress incontience ?

Answer 7

duloxetine

Question 8

Initial investigation in any urinary incontinence ?

Answer 8

Diary

Vaginal examination to exclude prolapse
And ability to initiate voluntary contraction of pelvic floor muscles

Urine dispstick and culture