MCQs on Urinary Incontinence

Written by Dr. Daniel Fraser (MBBS, FRACP) – Physician

Question 1

Maria, a 52-year-old woman, presents to your clinic complaining of involuntary leakage of urine, particularly when she coughs, laughs, or lifts heavy objects. These episodes have been occurring for the past 8 months and have gradually worsened. She denies any urgency or nocturia. Her medical history is significant for three vaginal deliveries, and she is currently postmenopausal. On examination, there is no pelvic organ prolapse, but there is reduced pelvic floor muscle tone.

Which of the following is the most likely diagnosis?

A) Urge incontinence
B) Overflow incontinence
C) Stress incontinence
D) Functional incontinence
E) Mixed incontinence

Correct Answer: C) Stress incontinence

Explanation:
Stress incontinence is characterized by involuntary leakage of urine during activities that increase intra-abdominal pressure, such as coughing, sneezing, or lifting. It is often associated with pelvic floor weakness, commonly due to vaginal childbirth and menopausal estrogen deficiency, both of which apply to this patient.

Why other options are incorrect:
A) Urge incontinence involves a sudden, compelling urge to urinate, often with no warning and may include nocturia. Maria does not report urgency or frequency.
B) Overflow incontinence typically results from bladder outlet obstruction or detrusor underactivity, leading to continuous dribbling and incomplete voiding—features not present here.
D) Functional incontinence is due to mobility or cognitive impairment, preventing timely toileting. Maria is independent and mobile.
E) Mixed incontinence combines stress and urge features. Since her symptoms are purely stress-related, this is less likely.

Question 2

Thomas, a 68-year-old man, visits your clinic due to frequent episodes of involuntary urine leakage. He reports a sudden urge to urinate that he is unable to defer, and occasionally does not reach the toilet in time. These symptoms have been progressively worsening over the last 6 months. He denies dysuria, hematuria, or stress-related leakage. He has a history of hypertension and type 2 diabetes, both well controlled. Physical examination and a digital rectal exam are unremarkable.

Which of the following is the most appropriate initial treatment?

A) Indwelling urinary catheter
B) Alpha-blocker therapy
C) Pelvic floor exercises
D) Antimuscarinic agent
E) Surgical bladder suspension

Correct Answer: D) Antimuscarinic agent

Explanation:
Thomas’s symptoms are consistent with urge incontinence, a common manifestation of overactive bladder, characterized by a sudden compelling need to void that is difficult to postpone. Antimuscarinic agents (e.g., oxybutynin, tolterodine) are first-line pharmacological treatments that work by inhibiting involuntary detrusor contractions, reducing urgency and frequency.

Why other options are incorrect:
A) Indwelling urinary catheter is not appropriate for long-term management and is associated with infection risk unless there is retention or end-of-life care.
B) Alpha-blockers are used for benign prostatic hyperplasia (BPH), which is not indicated here as DRE was normal and there’s no evidence of obstructive symptoms.
C) Pelvic floor exercises are more effective in stress incontinence rather than urgency-related leakage.
E) Surgical bladder suspension is used in stress incontinence, particularly in women, not in urge incontinence.

Question 3

David, a 75-year-old man, presents with continuous dribbling of urine, a weak urinary stream, and a sensation of incomplete bladder emptying. He often strains to initiate urination and reports getting up multiple times at night to void. These symptoms have gradually worsened over the past year. He has a history of long-standing benign prostatic hyperplasia (BPH). On examination, his bladder is palpable above the pubic symphysis.

Which of the following is the most likely cause of his incontinence?

A) Urge incontinence due to detrusor overactivity
B) Stress incontinence due to pelvic floor weakness
C) Overflow incontinence due to chronic urinary retention
D) Functional incontinence due to immobility
E) Mixed incontinence due to aging bladder

Correct Answer: C) Overflow incontinence due to chronic urinary retention

Explanation:
David’s presentation is typical of overflow incontinence, which occurs when the bladder is chronically overdistended and cannot empty effectively. Common signs include continuous dribbling, weak stream, nocturia, and a palpable bladder. The most common cause in elderly men is bladder outlet obstruction due to BPH.

Why other options are incorrect:
A) Urge incontinence typically presents with sudden urgency and involuntary voiding, but not with a palpable bladder or signs of obstruction.
B) Stress incontinence is rare in men and involves leakage during exertion, not continuous dribbling.
D) Functional incontinence is not applicable as David is able to access the toilet but has physical signs of retention.
E) Mixed incontinence may occur in older adults but the specific signs of retention and obstruction here strongly point to overflow.

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4. Nephrology & Urology Module

4.1 Hematuria

4.2 Chronic Kidney Disease

4.3 Urinary Incontinence

4.4 Prostate

4.5 Renal Tumors

4.6 Other Renal Disorders

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