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?