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 Medical Surgical Lifestyle interventions Vaginal oestrogen TVT Pelvic floor repair Pelvic floor exercises +/- biofeedback Duloxetine Vaginal cones Ring pessary

Overactive Bladder Conservative Medical Surgical Lifestyle interventions Vaginal oestrogen Sacral nerve root stimulation Bladder retraining Anti-muscarinics Botox Pelvic floor exercises 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 Duloxetine SNRI Increases urethral closure pressure 20-40mg bd SE: GI disturbance, headache, dry mouth, rarely suicidal ideation Vaginal Oestrogens e.g. Ovestin, Vagifem, Ortho-gynest All postmenopausal women not on HRT Oestrogen 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?