Two types - urge and stress. Establishing the type is essential for management
Urge Incontinence
- Over activity of the detrusor muscle - overactive bladder
- Suddenly feeling the urge to pass urine
- Significant impact on quality of life
Stress Incontinence
- Weakness in pelvic floor and sphincter muscles allows urine to leak at times of increased pressure on the bladder
- Typically when laughing, coughing or when surprised.
Mixed type
- Both can occur at the same time
- Need to identify which is causing the more significant impact and address that first
Overflow Incontinence
- When there is chronic urinary retention due to an obstruction in the outflow or urine
- Occurs without the urge to pass urine
- Anticholinergic medications, fibroids, pelvic tumours, neurological conditions (MS, Diabetic neuropathy and spinal cord injuries)
- More common in men - rare in women. Women suspected should be referred for urodynamic testing and specialist management
Management
Stress incontinence:
- Avoid caffeine, diuretics and overfilling the bladder
- Avoid excessive or restrictive fluid intake
- Weight loss if appropriate
- Supervised pelvic floor exercises for at least 3 months before considering surgery
- Duloxetine - SNRI used second line after surgery if not suitable candidate
Urge incontinence:
- Bladder retraining - gradually increasing time between going to the toilet for at least 6 weeks
- Anticholinergic medication - oxybutynin, tolterodine and solifenacin
- Mirabegron alternative to anticholinergic medications. Contraindicated in uncontrolled Essential hypertension
- Invasive options for those who have failed to respond to medical management:
- Botulinum toxin - injection into the bladder wall
- Percutaneous sacral nerve stimulation
- Augmentation cystoplasty - increase bladder volume using bowel tissue
- Urostomy on the abdomen