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Year 4 - OPIC > 3. Continence > Flashcards

3. Continence Flashcards

1
Q

What is urinary incontinence?

A

The involuntary leakage of urine.

The concept of social continence (ie. to void in a socially acceptable place at a socially acceptable time) highlights the impact of cognitive, physical and environmental aspects.

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2
Q

Give some changes that occur with ageing that may affect voiding.

A
  • increased collagen deposition in urethral and bladder walls result in decreased urethral closing pressure
  • prostatic volume increases with age, affecting the voiding stage of mictruition
  • reduced production of ADH, leading to reduced renal concentrating ability
  • atrophic vaginitis in postmenopausal women
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3
Q

List the bladder storage symptoms.

A
  • daytime frequency
  • nocturia
  • urgency
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4
Q

What is overactive bladder syndrome (OAB)?

A

A group of symptoms:

  • daytime frequency
  • nocturia
  • urgency

with or without incontinence, in the absence of UTI or other pathology.

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5
Q

List the bladder voiding symptoms.

A
  • hesitancy
  • slow stream
  • straining to void
  • feeling of incomplete emptying
  • need to immediately re-void
  • post-mictruition leakage
  • postural dependent mictruition
  • dysuria
  • urinary retention
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6
Q

What is stress urinary incontinence?

A

The involuntary loss of urine on physical examination, sneezing or coughing.

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7
Q

What is urgency urinary incontinence?

A

The involuntary loss of urine associated with urgency.

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8
Q

What is postural urinary incontinence?

A

The involuntary loss of urine associated with change of body position.

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9
Q

What is nocturnal enuresis?

A

The involuntary loss of urine occurring during sleep.

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10
Q

What is mixed urinary incontinence?

A

The involuntary loss of urine associated with urgency and also physical examination, sneezing, or coughing.

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11
Q

What is continuous urinary incontinence?

A

The continuous involuntary loss of urine.

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12
Q

What is insensible urinary incontinece?

A

Urinary incontinence where the patient is unaware of how it occurred.

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13
Q

What is functional urinary incontinence?

A

Urinary incontinence due to decreased motivation, initiative, or ability to get to the toilet when the need arises.

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14
Q

A patient presents complaining of urinary incontinence. What features of history should be explored?

A

Detailed social history, including access to toileting facilities, ability to attend to lower body hygiene, need for carers and aid toileting.

Obstetric history in women, including parity, instrumental delivery, and birth complications.

Surgical history (abdominal or pelvic) in men or women.

Detailed bowel history, including effect of constipation on LUTS, and presence of coexisting faecal incontinence.

Record of pad usage if using.

Impact on carer and assessment of carer burden should be sought.

Drug history.

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15
Q

What are the steps of a complete continence examination?

A
  • review of bladder and bowel diary
  • abdominal examination
  • urine dipstick and MSU
  • PR examination (including prostate examination in male)
  • external genitalia review (atrophic vaginitis in females)
  • post-micturition bladder scan
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16
Q

What is a bladder diary?

A

A useful tool to obtain reliable information on timings on voids and incontinence episodes.

A bladder diary is completed for three consecutive days and records volumes of fluid and food intake, as well as voided volume.

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17
Q

When examining the external genitalia as part of a continence examination, what should you look for?

A
  • Candida infection
  • contact dermatitis
  • vaginal atrophy
  • prolapse
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18
Q

What examining the abdomen as part of a continence examination, what should you look for?

A
  • previous surgical scars
  • palpable masses
  • faecal impaction
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19
Q

What is the indication of PR examination as part of a continence examination?

A
  • check anal tone
  • check presence of hard stool in the rectum
  • prostate examination in men
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20
Q

What is the indication of per vaginal examination as part of a continence examination?

A
  • vaginal atrophy
  • asking patient to cough to demonstrate any prolapse and stress incontinence
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21
Q

What is the purpose of performing a post-micturition bladder scan?

A

Post-void residual volume increases in the presence of:

  • severe constipation with faecal impaction
  • medications with anticholinergic effects
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22
Q

How can stress urinary incontinence be treated?

A
  • pelvic floor exercises
  • fluid intake
  • caffeine reduction
  • surgical intervention after MDT
  • treat constipation
23
Q

How can OAB be treated?

A
  • pelvic floor exercises
  • caffeine reduction
  • bladder retraining
  • oxybutynin
  • Botulinum toxin
24
Q

What is the conservative management of urinary incontinence?

A
  • reduction in caffeine intake
  • adequate hydration
  • bladder training
  • pelvic floor exercises
25
Q

What is bladder retraining?

A

Teaching the bladder to ‘hold on’ is a useful cognitive behavioural therapy technique. It is effective in cognitively intact patients, but in cognitively impaired patients results may be limited.

26
Q

Outline the role of containment products and toileting aids in incontinence.

A

Containment products can be used as an adjunct to definitive diagnosis and treatment.

They may also be necessary if treatment is unlikely to make them completely dry.

Many devices and pads are available.

27
Q

Outline the role of catheters in incontinence.

A

Indwelling catheter are not a viable long-term option for urinary incontinence due to risks of UTIs, local trauma and bypassing.

Intermittent catheterisation is preferable.

Catheter’s with ‘flip-flow’ valves or supra-pubic catheters are preferable in the long term.

28
Q

Give the

a) class of drug

b) indication for use

c) side effects

of oxybutynin.

A

a) anti-muscarinic

b) urgency; frequency; OAB; UI

c) constipation; dizziness; dry mouth; vision disorders

29
Q

Give the

a) class of drug

b) indication for use

c) side effects

of solifenacin.

A

a) anti-muscarinic

b) urgency; frequency; OAB; UI

c) constipation; dizziness; dry mouth; vision disorders

30
Q

Give the

a) class of drug

b) indication for use

c) side effects

of mirabegron.

A

a) sympathomimetic

b) urgency; frequency; UI

c) constipation; dizziness

31
Q

Give the

a) class of drug

b) indication for use

c) side effects

of trospium.

A

a) anti-muscarinic

b) urgency; frequency; UI

c) constipation; dizziness; dry mouth; vision disorders

32
Q

Give the

a) class of drug

b) indication for use

c) side effects

of toleradine.

A

a) anti-muscarinic

b) urency; frequency; UI

c) constipation; dizziness; dry mouth; vision disorders

33
Q

Give the

a) class of drug

b) indication for use

c) side effects

of tamsulosin.

A

a) alpha blocker

b) BPH

c) postural hypotension; dizziness; sexual dysfunction

34
Q

Give the

a) class of drug

b) indication for use

c) side effects

of doxazosin.

A

a) alpha blocker

b) BPH; HTN

c) dizziness; vertigo; dry mouth

35
Q

Give the

a) class of drug

b) indication for use

c) side effects

of finasteride.

A

a) 5-alpha reductase inhibitor

b) BPH

c) sexual dysfunction

36
Q

What are the consequences of constipation?

A
  • faecal impaction
  • incontinence
  • urinary retention
  • delirium
  • hospital admission
37
Q

What is faecal incontinence?

A

The involuntary loss of liquid or solid stool that is a social or hygienic problem.

38
Q

Give some risk factors for constipation.

A
  • inactivity
  • low fibre intake
  • low food intake
  • low fluid intake
  • polypharmacy
39
Q

What is the link between diabetes mellitus and constipation?

A

Diabetic autonomic neuropathy can result in slow colonic transit.

40
Q

Give some medications that increase the risk of constipation.

A
  • polypharmacy
  • anticholinergics
  • opiates
  • iron or calcium supplements
  • antacids
  • NSAIDs
41
Q

What changes in the ageing gut predispose to constipation?

A
  • reduced number of neurons in myenteric plexus
  • increased collagen deposit in left colon leading to reduced compliance and motility
42
Q

What changes in the ageing gut predispose to faecal incontinence?

A

Age-related decline in internal anal sphincter tone and thickness predisposes to faecal incontinence.

43
Q

For a bowel history, how long should a stool chart be recorded for?

A

1 week using Bristol stool chart to assess stool consistency.

44
Q

Alongside change in bowel habit, what symptoms should promote further assessment?

A
  • abdominal pain
  • fever
  • rectal bleeding or mucus
  • rectal pain
  • weight loss
  • anaemia
  • faecal incontinence
45
Q

What are the main differentials for a change in bowel habit?

A
  • diverticulitis
  • colon cancer
  • anorectal cancer
  • rectal ischaemia
  • IBS-C
46
Q

What is IBS-C?

A

Constipation-predominant irritable bowel syndrome (IBS-C) is a prevalent subtype of IBS among older people.

47
Q

When examining a patient with a change in bowel habit, what is essential?

A
  • DRE
  • proctoscopy
  • perineal examination
48
Q

Give some conservative steps that can be used to treat constipation.

A
  • maintain a regular and comfortable bowel habit
  • abdominal massage for constipation
  • increase fibre and fluid intake
  • advice on Probiotic supplementation
  • increasing physical activity
  • using suppositories to stimulate evacuation
49
Q

What pharmacological options are there to treat constipation?

A

First line bulk forming laxative (ispaghula).

Add osmotic laxative if ineffective (macrogol).

50
Q

What are the causes of faecal incontinence?

A
  • overflow faecal incontinence
  • dementia
  • frailty
  • loose stools
  • weak anal sphincters
51
Q

How can overflow faecal incontinence be managed?

A
  • avoid faecal impaction by use of stimulant and/or osmotic laxative
  • add in regular suppositories and enemasH
52
Q

How can faecal incontinence related to frailty and/or dementia be managed?

A
  • avoid impaction
  • carry out bowel care plan
  • regular prompted toileting
53
Q

How can faecal incontinence with loose stools be managed?

A
  • treat or remove identifiable causes (e.g. medications)
  • increase dietary fibre
  • consider loperamide
54
Q

How can faecal incontinence with weak anal sphincters be managed?

A
  • sphincter strenghtening exercises

Year 4 - OPIC (11 decks)

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