2.1. Geriatrics - Elderly Incontinence

Question 1

What is the definition of Urinary Incontinence?

Answer 1

Unintentional Passing of Urine

Question 2

What are the different types of Urinary Incontinence?

Answer 2

1. Stress Incontinence
2. Urge Incontinence - Overactive Bladder
3. Overflow Incontinence

Question 3

What is Bladder Control dependent on?

Answer 3

1. Functioning Bladder
2. Functioning Sphincters
3. Cognition
4. Mobility
5. Dexterity
6. Environment

Question 4

What factors affect Urinary Incontinence?

Answer 4

1. Environment - Mobility / Assistance / Toilet on a different Level
2. Co-Morbidities - Stroke / Bladder Outlet Obstruction / Cognitive Impairment / Spinal Cord Pathology
3. Age - Vaginal Atrophy / Prostate Hypertrophy / Increased Residual Volume / Decreased Bladder Capacity
4. Reversible Factors - UTI / Polydypsia / Medications / Prolapse / Delerium

Question 5

What is the Musculature of the Bladder?

Answer 5

1. Detrusor Muscle - Smooth Muscle (Involuntary)
2. Internal Urethral Sphincter - Smooth Muscle (Involuntary)
3. External Urethral Sphincter - Striated Muscle (Voluntary)

Question 6

What is the:

1. Parasympathetic Innervation of the Bladder?
2. Sympathetic Innervation of the Bladder?
3. Motor Innervation of the External Urethral Sphincter?

Answer 6

1. S2-4 - Detrusor Muscle Contraction (Urination)
2. a) T10-L2 - Detrusor Muscle Relaxation
3. b) T10-S2 - Internal Sphincter Contraction
4. S2-S4 - External Sphincter Contraction

Question 7

When does Stress Urinary Incontinence occur?

Answer 7

Increase in Intraabdominal Pressure - Cough / Sneeze / Laugh / Standing

Question 8

Why does Stress Urinary Incontinence occur?

Answer 8

The outlet from the Bladder is Weak:
1. Weak External Sphincter
2. Weak Pelvic Floor Muscles
Note - more common in women who have had children

Question 9

How is Urge Urinary Incontinence Described?

Answer 9

Incontinence associated with the Sudden Urge to Pass Urine

The Bladder contracts with Low Urine Volumes, increasing Frequency and Nocturnal Incontinence

Question 10

Why does Urge Urinary Incontinence occur?

Answer 10

Detrusor Muscle Instability (Overactive Bladder) due to an Upper Motor Neuron Lesion / Detrusor Muscle Disorder

Question 11

What is Overflow Urinary Incontinence?

Answer 11

Urine is retained in the Bladder with Subsequent Overflow - often due to Bladder Outlet Obstruction

Question 12

What are the Symptoms of Overflow Incontinence?

Answer 12

1. Hesitancy
2. Reduced Stream
3. Post-Mictruation Dribbling

Question 13

What investigations into Incontinence are done?

Answer 13

1. History - Type / Contributing Factors
2. Bladder Diaries - >3 days
3. Examination - Abdominal / PV / PR
4. Urinalysis / MSSU
5. Bladder Scan - Residual Volume
6. Urodynamics - Cystometry / Uroflowmetry

Question 14

What is the General Management of Elderly Incontinence?

Answer 14

1. Weight Control
2. Fluid Control - Volume / Type
3. Reduce Bladder Irritants - Caffeine / Alcohol
4. Pelvic Floor Exercises
5. Bladder Retraining
   Note - Pads / Urinals are not Treatments

Question 15

What are the Specific Treatments of Stress Urinary Incontinence?

Answer 15

1. Pelvic Floor Exercises (Kegel Exercises)

2. Surgery - Colposuspension / TVT Tape

Question 16

What are the Specific Treatments of Urge Urinary Incontinence?

Answer 16

1. Bladder Retraining Programme
2. Prompted, Regular Toileting
3. Medications - Anticholinergic / Beta-3-Adrenceptor Agonist
4. Botulinum Toxin (BoTox)
5. Sacral Nerve Stimulation

Question 17

What are the Specific Treatments of Overflow Urinary Incontinence?

Answer 17

1. Relieve the Obstruction - Anti-Andgrogen / TURP
2. Relax the Sphincter - Alpha-Blockers
3. By-pass the Obstruction - Catheter
   Note - Catheters should be a last resort