URINARY INCONTINENCE

HISTORY TAKING AND PE RISK FACTORS

Categorise the womans urinary incontinence (UI) Vaginal delivery
as stress (SUI), mixed (MUI), or urgency/overactive - Prolonged second stage
bladder (OAB) - instrumental delivery,
In mixed urinary incontinence, direct treatment - Large infants
towards the predominant symptom. Congenital factors affecting the collagen
If stress incontinence is the predominant symptom metabolism
in mixed urinary incontinence, discuss with the - Ehlers-Danlos syndrome
woman the benefit of conservative management, Menopause
including drugs for overactive bladder, before - Atrophy of collagen connective tissue
offering surgery. Chronic predisposing factor
- increased in intra-abdomminal pressure:
Assessment of pelvis floor muscles Obesity, chronic cough, constipation, heavy
Routine digital assessment to confirm pelvis floor lifting or pelvic mass
muscle contraction before the use of supervised Iatrogenic factors
pelvic floor muscle training. - Pelvic surgery such as hysterectomy
Bladder diaries Medication
Record fluid intake, voiding times and volumes, - Diuretic, sedative
leakage episodes, pad use, and other information Social factors
such as degree of urgency or incontinence in UI or - Smoking, alcohol, coffee
OAB minimum for three days.

INVESTIGATION
MANAGEMENT
Urine dipstick and MSU (DM, infection)
Lifestyle modifications
Bladder diary
Caffeine reduction to women with OAB
USS
Modification of high or low fluid intake in women
- Mass, ascites, post void volume
with UI or OAB
Urodynamic study
UI/OAB who have a BMI >30 to lose weight
Cystoscopy

MANAGEMENT
Stress or mixed urinary incontinence
1. Pelvic floor muscle training
- 8 contractions performed 3x/day at least for 3
months
2. Surgical
- Retropubic mid-urethral tape procedures.
- Colposuspension; involves the placement of
permanent stitches at the level of the bladder
neck, which serve to lift up the bladder neck)
3. Duloxetine (SNRI)
- Not first line
- Not routinely offer as 2nd line unless she
prefers medication to surgical or not suitable
for surgery.
MANAGEMENT
Overactive bladder/urge incontinence
1. Bladder training
2. Anti-muscarinic;
- Oxybutynin: dont offer to frail older women
(multiple comorbidities, functional impairment,
and cognitive impairment) as this formulation
crosses blood brain barrier and can affect
cognitive functioning.
- Tolterodine (Immediate release)
- Darifenacin (OD preparation)
3. Invasive therapy (after MDT review)
- Botulinum toxin A
- Percutaneous sacral nerve simulation
- Percutaneous posterior tibial nerve stimulation