Urinary incontinence

In men

• Most commonly due to enlargement of the prostate
• Urge incontinence or dribbling may result from the partial retention of urine
• TURP and other pelvic surgery may weaken the bladder sphincter and cause incontinence

In women

• Functional incontinence

o       When physiological factors are relatively unimportant

o       The patient is caught short in finding the toilet because of immobility or unfamiliar surroundings

• Stress incontinence
  • Leakage of urine due to an incompetence sphincter – typically occurring when intra-abdominal pressure rises
  • There may be slippage of the proximal 1/3 of the urethra and the bladder neck out f the abdominal cavity
  • Increasing age and obesity are risk factors
• Urge incontinence
  • Also known as overactive bladder syndrome
  • The urge to urinate is quickly followed by uncontrollable and sometimes complete emptying of the bladder and the detrusor muscle contracts
  • Look for evidence of stroke, Parkinsons, dementia
• Other causes;
  • Urinary infection
  • Diabetes
  • Diuretics

Management

• Check for – UTI, DM, diuretic use, faecal impaction. Do U&Es
• Stress incontinence
• Pelvic floor exercises may help
• Ring pessary may help uterine prolapse
• Duloxetine can be given
• Minimal access surgery is available e.g. Burch coloposuspension and sling procedures
• Urge incontinence
• Examine for spinal cord and CNS signs
• Maximise access to the toilet and give advice on toileting regime

• Do urodynamic assessment (cystometry and urine flow rate measurement) before any surgical intervention to exclude detrusor instability or sphincter dyssergia