Management of Urinary Incontinence

Depends on the patient!• Age• Effect on quality of life• Type of incontinence• Presence of prolapse

Activity!

• Sort the cards into management options for stress incontinence or overactive bladder.

• Line them up in the order that you would offer them, there may be more than one at the same time.

• Of course, not every option is suitable for every patient.

Stress incontinence

Conservative• Lifestyle

interventions• Pelvic floor

exercises +/- biofeedback

• Vaginal cones• Ring pessary

Medical• Vaginal oestrogen• Duloxetine

Surgical• TVT• Pelvic floor repair

Overactive Bladder

Conservative• Lifestyle

interventions• Bladder

retraining• Pelvic floor

exercises

Medical• Vaginal

oestrogen• Anti-muscarinics

Surgical • Sacral nerve

root stimulation• Botox• Detrusor

myomectomy• Augmentation

cystoplasty

Lifestyle Interventions

Pelvic Floor Exercises

• More effective if supervised• +/- biofeedback• Refer to community continence services• Vaginal cones

Bladder Retraining

• To re-establish cortical control over voiding• Regular voiding, gradually increasing

intervals.• Using distraction and relaxation techniques• Bladder diary will show improvement

Ring Pessary

• Anterior prolapse predisposes to stress incontinence

• Changed every 4-6 months• Conservative option

Anti-muscarinic medication

• Oxybutinin 2.5mg, 5mg• Tolterodine (Detrusitol), Trospium (Regurin)• CI: myasthenia gravis, significant bladder outflow obstruction or urinary

retention, severe ulcerative colitis, toxic megacolon, and in gastro-intestinal obstruction or intestinal atony.

• SE: dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention)

• Try several before giving up

Other medications

DuloxetineSNRIIncreases urethral closure pressure20-40mg bdSE: GI disturbance, headache, dry mouth, rarely suicidal ideation

Vaginal Oestrogense.g. Ovestin, Vagifem, Ortho-gynestAll postmenopausal women not on HRTOestrogen breaks advised (?endometrial Ca risk)

Surgery for Stress Incontinence

• Tension-free Vaginal tape (TVT)

• Pelvic Floor Repair

Surgery for Overactive Bladder

• A last resort!• Sacral nerve root stimulation• Botox• Detrusor Myomectomy• Augmentation Cystoplasty

Any Questions?