NCWO Continence Care 1 — Questions and Answers
Question 1: Stress urinary incontinence (SUI) is caused by:
- Involuntary bladder contractions overcoming sphincter resistance
- Inadequate urethral sphincter resistance during increased intra-abdominal pressure (Correct answer)
- Inability to reach the toilet in time due to mobility deficits
- Overflow of urine from an overdistended bladder
Correct answer: Inadequate urethral sphincter resistance during increased intra-abdominal pressure
SUI results from weakened urethral sphincter or pelvic floor muscles that cannot maintain continence when intra-abdominal pressure suddenly rises with coughing, sneezing, or exercise.
Question 2: Overactive bladder (OAB) is characterized by:
- Leakage with coughing or lifting due to sphincter weakness
- Urgency, with or without urgency incontinence, usually with frequency and nocturia (Correct answer)
- Inability to empty the bladder causing overflow dribbling
- Loss of urine due to a fistula between bladder and vagina
Correct answer: Urgency, with or without urgency incontinence, usually with frequency and nocturia
OAB is defined by urgency—a sudden, compelling desire to void—occurring with or without leakage, typically accompanied by urinary frequency and nocturia.
Question 3: The first-line conservative treatment for stress urinary incontinence in women is:
- Anticholinergic medication
- Pelvic floor muscle training (Kegel exercises) (Correct answer)
- Surgical sling placement
- Indwelling urinary catheter
Correct answer: Pelvic floor muscle training (Kegel exercises)
Pelvic floor muscle training (PFMT) strengthens the urethral sphincter and pelvic floor, reducing SUI leakage and is the first-line evidence-based intervention.
Question 4: Bladder training for urge incontinence involves:
- Catheterizing the patient on a fixed schedule to prevent involuntary voids
- Gradually increasing the interval between voids to re-establish normal bladder capacity (Correct answer)
- Restricting fluid intake to less than 1000 mL per day
- Applying a pessary to support the bladder neck
Correct answer: Gradually increasing the interval between voids to re-establish normal bladder capacity
Bladder training systematically extends the voiding interval—teaching the patient to suppress urgency—thereby gradually increasing bladder capacity and reducing leakage episodes.
Question 5: Prompted voiding is a continence intervention primarily used for:
- Cognitively intact patients with pure SUI
- Cognitively impaired or dependent residents who lack independent voiding awareness (Correct answer)
- Patients with urinary retention requiring intermittent catheterization
- Children with primary nocturnal enuresis
Correct answer: Cognitively impaired or dependent residents who lack independent voiding awareness
Prompted voiding is designed for cognitively impaired or physically dependent individuals who cannot initiate voiding independently but can respond to caregiver prompts.
Question 6: Incontinence-associated dermatitis (IAD) is distinguished from pressure injury by:
- IAD always has depth into subcutaneous tissue
- IAD presents as superficial erythema or skin breakdown caused by moisture/irritants, not pressure (Correct answer)
- IAD exclusively occurs over bony prominences
- IAD causes full-thickness tissue loss
Correct answer: IAD presents as superficial erythema or skin breakdown caused by moisture/irritants, not pressure
IAD is a moisture-associated skin damage confined to the epidermis and dermis caused by exposure to urine or feces, while pressure injuries result from sustained mechanical loading.
NCWO Continence Care 1
Stress urinary incontinence (SUI) is caused by: