Urinary incontinence

Question 1

Definition

Answer 1

Involuntary leakage of urine due to inability to control the bladder.

Question 2

Types of urinary incontinence

Answer 2

• Stress incontinence
• Urge incontinence
• Mixed incontinence
• Overflow incontinence
• Functional incontinence

Question 3

Stress incontinence

Answer 3

Involuntary leakage during activities that increase abdominal pressure e.g.
- Coughing
- Sneezing
- Exercise
Caused by weakened pelvic floor muscles or an impaired urethral sphincter

Question 4

Urge incontinence

Answer 4

Involuntary leakage accompanied by a strong, sudden need to urinate, usually due to overactive bladder muscle contraction.
Triggers:
- Neurological disorders
- Infections
- Bladder irritants

Question 5

Mixed incontinence

Answer 5

Combination of two or more types of incontinence.
Stress and urge incontinence MC combination.
Px may experience clinical features of both

Question 6

Over flow incontinence

Answer 6

• Involuntary leakage caused by an inability to completely empty the bladder, often due to an obstruction or poor bladder muscle function

Question 7

Functional incontinence

Answer 7

Inability to reach the toilet in time due to physical or cognitive impairments, despite normal bladder function

Question 8

Epidemiology

Answer 8

• Age
• Female
• Previous pregnancies and deliveries: esp linked to stress incontinence due to weakness of the pelvic floor
• Obesity
• Menopause
• Neurological disorders
• Urinary tract infections
• Certain medications: diuretics, doxazosin and oxycodone

Question 9

Signs

Answer 9

• Perianal skin irritation
• Damp underwear

Question 10

Symptoms

Answer 10

• Involuntary urine leakage: suddenly is linked to urge; with increases in intra-abdominal pressure is linked to stress
• Urgency (mainly urge)
• Increased frequency

Question 11

Investigations

Answer 11

Thorough history
Urinalysis:
- Infection
- Haematuria
- Glucose
* Above may contribute to incontinence *
Bladder diary: document fluid intake, voiding frequency, and episodes of incontinence for 3-7 days
Post-void residual urine (PVR): Assess bladder emptying using USS or catheterization
Urodynamic testing: Measures bladder pressure and function. usually reserved for complex cases or before surgery.

Question 12

Criteria fro 2 week wait for bladder cancer

Answer 12

• 45 + with unexplained visible haematuria without UTI, or visible haematuria that is persistent or recurrent after successful treatment of UTI
• 60 + with unexplained non-visible haematuria and dysuria or a raised white cell count on a blood test

Question 13

Treatment stress incontinence

Answer 13

= Manage reversible risk factors: weight loss
= Life style mods:
- Smoking cessation
- Fluid management
- Avoidance of bladder irritants such as caffeine
FIRST LINE = Pelvic floor muscle training: 3 months kegal exercises
= Surgery
Second line = Duloxetine (SNRI)

Question 14

Urge incontinence treatment

Answer 14

• Bladder training: scheduled voiding with gradually increasing intervals between voids to improve bladder control
• Antimuscarinitic drugs e.g OXYBUTYNIN = decreases bladder contractions and increases bladder capacity
• Mirabegron = beta-3 adrenergic agonist that relaxes the bladder muscles and increases its capacity, used for overactive bladder and urge incontinence
• Specialist referral: secondary care treatment options:
  = injection of botulinum toxin type A into the bladder wall,
  = percutaneous sacral
  = nerve stimulation,
  = augmentation cystoplasty,
  = urinary diversion

Question 15

Complications

Answer 15

• Social isolation
• Psychological problems
• Sexual problems
• Poor sleep due to nocturia