URINARY INCONTINENCE - Common Patterns Adults

1)      Stress incontinence – 50% of cases, stress incontinence +++, urge incontinence +, urgency, frequency, normal cystometry, Mx – In all cases except mild sx, medical unfitness for surgery and patient’s unwillingness, surgery is indicated, non-surgical methods include pelvic floor exercises, vaignal continent devices,  other general measures for incontinent include – incontinent pads, fluid restriction, avoidance of caffeine-containing products, medial management of cough and  constipation

2)      Detrusor instability – 40% cases, urgency, urge incontinence, stress incontinence, enuresis, frequency, nocturia, incontinence during sexual intercourse, Ix – urodynamic demonstration of failure to inhibit detrusor contractions during cystometry, Mx – general measures for incontinence as mentioned under stress incontinence, bladder drilling – passing urine every 1.5 hrs, not passing urine in between even if incontinent, continue until patient remain continent for 1.5 hrs, then increasing the voiding intervals half hourly and repeating the above steps until desired goals achieved, oxybutynin 2.5-5 mg tid, Tolterodine 1-2 mg daily (?),  imipramine  50 mg nocte, propantheline 30-60 mg qid, DDVAP 40 mcg nocte, finally surgery on failure of medical therapy,

3)      Lower urinary tract infections

4)      Functional incontinence

5)      Autonomic Dysfunction Syndromes – See under MMSSCs

 

» SYMPTOM, SIGNS, SYNDROMES GLOSSARY