Urinary incontinence

Question 1

Types of incontinence

Answer 1

1. Stress - pelvic floor/spincter weakness(with cough, laugh)
2. Urge - Bladder muscle detrusor overaction (little urine-has to go, leaks on the way to bathroom)
3. Mixed - both
4. Quiet dribble
5. Continuous leakage
6. Reflex (neuropathic bladder

Question 2

Investigations for incontinence3.

Answer 2

Initial: Dipstick, Urine microscopy & culture
(R/O UTI first)

Best: Urodynamic study

Question 3

Drugs causing incontinence

Answer 3

1. ACEI
2. Prazosin (HTN)
3. Labetolol
4. Phenoxybenzamine
5. Anticholinergics - overflow inc
6. Cholinergics - urge inc (stimulates bladder)
7. Sedatives, alcohol, caffeine, lithium, loop diurectics(furesemide) - urge inc

Question 4

*Mx of incontinence

Answer 4

1. Stress inc:
   ●Pelvic floor muscle exercise - 3 months min (initial)
   ●Sx rx if not improved
2. Urge inc:
   ●Bladder retraining (initial)
   Not better
   ●Anticholinergics - oxybutynin, solifenacin, tolterodine
   Not better
   ●Sx

Question 5

Mx of incontinence a/w uterovaginal prolapse

Answer 5

●Asymptomatic
Pelvic floor exercises
Life style modifications

●Symptomatic
Ring pessaries
if needed
Sx correction