1. What is the prevention and management in urinary incontinence?

Prevention
Little scientific evidence is available to guide preventive efforts for UI, but based on
etiologies and exacerbating factors, reasonable measure include:
preventing chronic constipation
treatment of vaginal atrophy
avoidance of obesity (pelvic floor)
maximize ADL function treat pain, assistive devices
encouraging regular toileting
prudent dosage and timing of diuretics
avoidance of iatrogenic (mainly medication-related) UI
early detection and treatment of prostatic enlargement, pelvic floor weakness
encouraging exercises to strengthen pelvic floor and abdominal muscles
o good evidence suggesting loss of pelvic floor support is associated with voiding
dysfunction
o beginning Kegel exercises and other preventive measures early in life
Management
Non-pharmacologic treatment
i. Dietary modification
o Avoidance of food and beverage irritants
o Limiting fluids before bedtime (but not overall fluid intake)
ii. Behavior modification
o Kegel exercises relaxing and contracting pubococcygeus muscle
Patient must be highly motivated
First line for stress incontinence; second for urge incontinence
Biofeedback helps identify when contracting correctly
Vaginal weights, same purpose as biofeedback
o Bladder retraining gradual increase in time between voids
o Scheduled toileting
o Prompted voiding asking patient if he/she needs to use toilet
iii. Devices for stress incontinence
o Pessaries prolapse management
o Urethral plugs
o Vaginal cone
iv. Incontinence products
o Underwear absorbent pads
o Disposable adult briefs (pull-ups); adult diapers
o Absorbent cloth or disposable bed pads
v. Catheters
o Intermittent Cath Procedure (ICP) clean technique, not sterile
Re-use of catheter; self-ICP or done by someone else
Patient education handouts for procedure and clean technique management
Strongly preferred in patients with urinary retention problems since indwelling
catheters do result in complications over time
o Male external catheter
Aka: condom or Texas catheters
Not for urinary retention problems; only for those able to empty the bladder
o Indwelling transurethral catheter
Urethral trauma risk
o Suprapubic catheter
Leg bag during day; large volume bag at night
Transurethral and suprapubic risks include chronic infections, bladder stones,
sepsis, hematuria, bladder cancer (long term)
Catheters are used as a last resort. Appropriate situations include:
- Urinary retention that cannot be corrected medically or surgically, or with
intermittent catheterization and there is persistent overflow UI, infections or
renal dysfunction (AMDA 2005)
- Palliative or hospice care as a comfort measure
- Patient preference if no response to specific treatment patient whose quality
of life is very poor due to UI
- Short-term use to allow skin wounds to heal
Pharmacologic treatment
i. Anticholinergics is use to;
Inhibit the involuntary contractions of the bladder
Increase capacity of the bladder
Delay the initial urge to void
Drugs include;
- Propantheline (ProBanthine)
- Oxybutynin (Ditropan, Oxytrol)
- Tolterodine (Detrol)
- Hyoscyamine (Levbid, Cystospaz)
- Trospium (Sanctura)
- Darifenacin (Enablex)
- Solifenacin (Vesicare)
- Fesoterodine (Toviaz)
ii. Alpha-Blockers
Relax smooth muscles and improve urine flow
They are useful for men with benign prostatic hyperplasia who also have urge
incontinence.
Drugs includes;
- terazosin (Hytrin)
- doxazosin (Cardura)
- tamsulosin (Flomax)
- alfuzosin (Uroxatral)
- silodosin (Rapaflo)
Alpha-blockers are sometimes combined with anticholinergics to treat men with
moderate-to-severe lower urinary tract symptoms, including overactive bladder.

iii. Anti-depression
Use for both urge and stress incontinence.

iv. Surgery
To restore the bladder neck
and urethra to their anatomically correct positions