urinary incontinence

Question 1

urinary incontinence, types and risk factors

Answer 1

urinary incontinence - involuntary leakage of urine

urgency - sudden immediate need to pass urine

stress - leakage on exertion, effort, sneeze or cough

mixed - urgency and stress but one type is predominant

risk factors:
- elderly
- pregnant
- obesity
- drugs (diuretics, alcohol, caffeine)

Question 2

treatment

Answer 2

non drug - monitor fluid intake, weight loss if obese, reduce caffeine

urgency
1st line - bladder training for at least 6 weeks
2nd line - antimuscarinic (oxybutynin or tolterodine)
3rd line - mirabegron

stress
1st line - pelvic floor training for at least 3 months
2nd line - surgery or duloxetine

mixed
- bladder > 6 weeks + pelvic > 3 months
- drug treatment for type that is predominant

Question 3

antimuscarinic imp points

Answer 3

oxybutynin, tolterodine, fesoterodine, solifenacin, trospium

increase adverse effects in elderly
- dry mouth, constipation, dizziness, drowsiness, tachycardia

C/I:
- angle-closure glaucoma
- GI obstruction

antimuscarinics can affect the performance of skilled tasks e.g. driving

Question 4

nocturnal enuresis - non drug treatment

Answer 4

involuntary urination during sleep - in children

children < 5 should resolve without intervention

for > 5:
- non drug - fluid intake, toileting behaviour, reward systems

• if no response to advice and > 1-2 wet beds per week - ENURESIS ALARM - continue until 2 weeks of dry nights
• if alarm treatment unsuccessful - add in/replace with desmopressin

Question 5

nocturnal enuresis - drug treatment

Answer 5

children > 5 - desmopressin:
- when alarm is undesirable
- when need rapid results (to cover holidays)
- assess treatment after 4 weeks
- continue for 3 months if responding
- withdraw before giving for 3 month interval again

specialist: desmopressin +/- antimuscarinic (oxybutynin or tolterodine)

still not responding: imipramine

Question 6

desmopressin - imp points

Answer 6

much more potent and longer duration of action than vasopressin

selective for V2 receptors - no vasoconstrictive effect

SEs:
- hyponatraemia (if given rapidly) - convulsions
- nausea