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3: Elderly Y3 - Integrated Care [9] > [11] Incontinence > Flashcards

[11] Incontinence Flashcards

1
Q

What is urinary incontinence/

A

Uncontrolled leakage of urine

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2
Q

Why is urinary incontinence important?

A

It is a common and distressing problem, with large impact on QoL

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3
Q

What is faecal incontinence?

A

Inability to control the passage of gas or stools through the anus.

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4
Q

What is nocturia?

A

Need to wake during the night to pass urine >2 times

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5
Q

What is nocturnal enuresis?

A

Urinary incontinence whilst sleeping

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6
Q

What is hesitancy?

A

Difficulty starting or maintaining flow of urine

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7
Q

What is urgency?

A

Sensation of imminently needing to pass urine

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8
Q

What is frequency?

A

Need to pass urine more often than normal

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9
Q

What is functional incontinence?

A

the patient is unable to reach the toilet in time

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10
Q

Give 2 causes of functional incontinence?

A
  • Poor mobility

- Unfamiliar surroundings

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11
Q

What is stress incontinence?

A

Involuntary leakage of urine on effort or exertion, or sneezing or coughing

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12
Q

What is urge incontinence?

A

Involuntary leakage accompanied by, or immediately preceded by, urgency of micturition – there is a sudden and compelling desire to urinate that cannot be deferred

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13
Q

What is mixed incontinence?

A

Involuntary leakage associated with urgency and stress

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14
Q

What is overflow incontinence?

A

When bladder becomes dilated or flaccid, with minimal or no tone/function

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15
Q

What is true incontinence?

A

Continuous leakage of urine

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16
Q

How is continence maintained?

A

By the co-ordinated interaction of the bladder, urethra, pelvic floor muscles, and the nervous system

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17
Q

What happens to the pressure in the bladder as it fills?

A

Increases slowly

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18
Q

What rate does the bladder fill?

A

Usually 0.5-5ml per hour

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19
Q

What is the capacity of the bladder?

A

500ml

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20
Q

At what level of bladder fullness will the desire to void be felt?

A

About 250ml

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21
Q

When is continence maintained, with regard to pressure?

A

When pressure in the urethra exceeds bladder pressure

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22
Q

What does the process of micturition involve?

A

The voluntary relaxation of striated muscle around urethra, reducing urethral pressure, and a corresponding increase in bladder pressure as a consequence of detrusor contraction

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23
Q

What kind of nervous control is passing of urine under?

A

Parasympathetic

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24
Q

Where do bladder afferent signals travel?

A

From the bladder, ascend through the spinal cord and then project to pontine micturition centre and cerebrum

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25
Q

What nervous signals are sent from the pontine micturition centre upon the voluntary decision to urinate?

A

Neurones of the pontine micturition centre fire to excite the sacral preganglionic neurones

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26
Q

What is the result of the excitation of the sacral preganglionic neurones on the conscious decision to urinate?

A

There is parasympathetic stimulation to the pelvic nerve (S2-4) causing a release of ACh

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27
Q

What does the ACh released by the pelvic nerve cause?

A

Works on M3 muscarinic ACh receptors on the detrusor muscle, causing it to contract and increase intra-vesicular pressure

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28
Q

Other than sending nervous signals to the sacral preganglionic neurones, what is the role of the pontine micturition centre?

A

Inhibits Onuf’s nucleus

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29
Q

What is the result of the inhibition of Onuf’s nucleus?

A

Reduction in sympathetic stimulation to the internal urethral sphincter causing relaxation

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30
Q

What happens to the external urethral sphincter during micturition?

A

There is a conscious reduction in voluntary contraction of the external urethral sphincter, allowing for the distention of the urethra and passing or urine

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31
Q

What assists urination in the female?

A

Gravity

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32
Q

What assists urination in the male?

A

Bulbospongiosus contractions and squeezing along the length of the penis

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33
Q

What can cause stress UI?

A
  • Urethral hypermobility

- Sphincter deficiency

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34
Q

What structures can be involved in urethral hyper mobility?

A
  • Pelvic floor muscle

- Urethral support

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35
Q

What structures can be involved in sphincter deficiency?

A
  • Pudendal innervation
  • Urethral striated muscle
  • Smooth muscle function
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36
Q

When is stress UI most commonly seem?

A

After childbirth

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37
Q

What is urge UI also known as?

A

Overactive bladder or detrusor over-activity

38
Q

What can cause urge UI?

A
  • Idiopathic
  • Neurogenic
  • Infective
  • Bladder outlet obstruction
39
Q

What is the most common cause of urge UI?

A

Idiopathic

40
Q

What can cause neurogenic urge UI?

A
  • MS
  • Parkinsonism
  • Stroke
  • Spinal cord injury
41
Q

What can cause infective urge UI?

A

UTI

42
Q

What are the main causes of overflow incontinence?

A
  • Detrusor failure

- Obstruction

43
Q

What are the causes of detrusor failure?

A
  • Neurological
  • Medication induced
  • Diabetes
  • Spinal surgery
44
Q

What are the causes of obstruction?

A
  • Enlarged prostate
  • Bladder stones
  • Tumour
  • Urethral stricture
45
Q

What can cause functional incontinence?

A
  • Inability to communicate need to go to toilet
  • Immobility
  • Sedation
  • Unfamiliar surroundings
  • Cognitive impairment
  • Clothing
46
Q

Where does functional incontinence often occur?

A

In hospital

47
Q

What are the risk factors for UI?

A
  • Female gender
  • Obesity
  • Age
  • Neurological disease
  • Urinary infection
  • Post-menopausal
  • Post-hysterectomy
  • Bladder outlet obstruction
48
Q

Why are females more at risk of UI?

A
  • Bladder outlet weaker

- Childbirth

49
Q

Why is the bladder outlet weaker in females?

A

Due to shorter urethra and lack of prostate

50
Q

What damage occurs during childbirth that increase the risk of UI?

A

Combination of ligament and nerve damage

51
Q

Why does obesity increase the risk of UI?

A

Causes increased strain and weakening of pelvic floor

52
Q

Why does age increase the risk of UI?

A
  • Reduced bladder capacity
  • Reduced blood flow
  • Reduced total collagen
  • Slowing of nerve conduction time
  • Degenerative changes to urethral support structures
53
Q

What simple investigations can be done in UI?

A
  • Frequency/volume charts
  • Urinalysis
  • Blood tests
  • Imaging
54
Q

Why can frequency/volume charts be helpful in UI?

A

Help determine cause of urinary incontinence

55
Q

How should frequency/volume charts be completed?

A

Patients should complete a diary over a 3 day period that records fluid intake, volume of urine passes, and episodes of incontinence

56
Q

What does frequent small volumes of urine on frequency/volume chart indicate?

A

Overactive bladder

57
Q

What does >1/3 of 24 hour urine produced at night on frequency/volume chart indicate?

A

Noctural polyuria

58
Q

What does >2500ml/24 hours on frequency/volume chart indicate?

A

Polyuria

59
Q

What should be checked for on urinalysis in UI?

A
  • Glucose
  • Protein
  • Leucocytes and nitrates
  • Blood
60
Q

What might glucose on urinalysis indicate in UI?

A

Diabetes

61
Q

What might protein on urinalysis indicate in UI?

A

Primary kidney pathology

62
Q

What might leucocytes and nitrates on urinalysis indicate in UI?

A

UTI

63
Q

What might blood on urinalysis indicate in UI?

A
  • Renal stones

- UT malignancy

64
Q

What blood tests should be done in UI?

A
  • FBC
  • U&Es
  • Glucose
  • Calcium
65
Q

Why should calcium be done in UI?

A

Useful to rule out hyperglycaemia. which can cause constipation and confusion

66
Q

What imaging may be done in UI?

A
  • Post void bladder scan
  • USS abdo
  • CT urography
  • CT abdo
  • Intravenous urogram
67
Q

When is a post-void bladder scan the 1st line diagnosis?

A

To rule out retention

68
Q

When might USS abdomen be done in UI?

A

Required if renal failure to evaluate kidney size and look for signs of obstructive uropathy

69
Q

When might CT urography be done in UI?

A

If considering renal stones

70
Q

When might CT abdomen be done in UI?

A

Exclude abdominal or pelvic masses if suspected

71
Q

When might IV urogram be done in UI?

A

Useful if renal stones are suspected, but largely superseded by CT urography in most centres

72
Q

What specialist investigations may be done in UI?

A
  • Uroflowmetry
  • Ultrasound cystodynamogram
  • Cystometry
  • Videourodynamics
  • Ambulatory urodynamics
73
Q

What does uroflowmetry measure?

A

Urine flow rates

74
Q

Is uroflowmetry invasive?

A

No

75
Q

What is uroflowmetry useful for?

A

Diagnosing bladder outlet obstruction

76
Q

What is an ultrasound cystodynamogram?

A

Combines pre and post void bladder scanning and gives information regarding functional bladder capacity, flow rate, and post-void bladder volume

77
Q

What is cystometry?

A

Measurement of bladder pressure, sensation, capacity, and compliance during filling and voiding

78
Q

What happens in cystometry?

A

The bladder is filled with saline whilst a pressure transducer is placed in the bladder and rectum

79
Q

What is videourodynamics?

A

Combination of cystometry and radiographic screening

80
Q

What is done in ambulatory urodynamics?

A

Measurement of physiological fillings and pressures during patients daily routine

81
Q

How is ambulatory urodynamics done?

A

Uses pressure transducer and connects it to small device and uses electronic continence pads

82
Q

I haven’t done pads n catheters n shit, do u want me to or do you know it?

A

:)

83
Q

What patient education should be done in stress UI?

A
  • Smoking cessation
  • Weight reduction
  • Managing constipation
  • Reducing alcohol and caffeine
84
Q

What is the first line management for women with SUI or mixed UI?

A

Pelvic floor muscle exercises

85
Q

What should be offered regarding pelvic floor muscle exercises?

A

Supervised pelvic floor muscle training for at least 3 months

86
Q

What should programmes of pelvic floor muscle training consist of?

A

At least 8 contractions performed 3 times a day

87
Q

What pharmacological management is there for stress UI?

A

Duloxetine

88
Q

Who should be offered surgical management for stress UI?

A
  • Women who prefer pharmacological management to surgical

- Not suitable for surgical treatment

89
Q

What kind of drug is duloxetine?

A

SNRI

90
Q

How does duloxetine work in SUI?

A

Increases activity of external urethral sphincter during filling phase

91
Q

What are the surgical options for stress UI?

A
  • Colposuspension

- Autologous rectus fascial sling

92
Q

What happens in colposuspension?

A

The neck of the bladder is lifted up and stitched into this position

3: Elderly Y3 - Integrated Care [9] (14 decks)

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