AC - Continence Flashcards
What is the pathophysiology & aetiology of urge incontinence?
- Overactive detruser - CVA, MS, local irritants (UTI, tumour)
- Poor bladder tone - drugs, neuropathy, spinal cord injury, pelvic injury/trauma
What drugs are associated with urge incontinence?
SSRIs, anticholinesterase inhibitors, cholinergic durgs, caffeine, alcohol
What are the clinical features of urge incontinence?
Unexpected loss at times associated with strong desire to void (urgency)
Can also be associated with frequency, nocturia +/- dysuria
What is the management of urge incontinence?
- Exclude reversible/Rx causes (UTI, tumour, constipation, drugs)
- Lifestyle modification (bladder deferment techniques, reduce caffeine and alcohol intake)
- Medications - anticholinergics (oxybutynin), TCA
What is the pathophysiology/aetiology of stress incontinence?
- Underactive sphincter function
2. Hypermobility of bladder neck/urethra and weak pelvic floor muscles (i.e. childbirth, trauma/surgery, menopause)
What are the clinical features of stress incontinence?
Leakage during times of raised intra-abdominal pressure
- Coughing, sneezing
- Laughing
Lifting, exercise
How can stress incontinence be managed?
- Exclude reversible/treatable organic causes (Rx chronic cough, Medication review alpha-blockers used for BPH (reduce function of sphincter – SMC relaxant) , Constipation/faecal loading
- Non-pharmacological (Pelvic floor exercises, Weight loss)
- Pharmacological ( Alpha-agonists +/- topical oestrogens)
What is the pathophysiology/aetiology of overflow incontinence?
Bladder Failure
- Underactive bladder (detrusor) contractility
- Overactive bladder outlet (sphincter) function
Obstruction
3. Obstruction of bladder outlet BPH, tumour, strictures
What are the clinical features of overflow incontinence?
Involuntary loss of small amounts, often dribbling nature, of urine from a small bladder
Chronic retention symptoms suprapubic fullness/discomfort, terminal dribbling, hesitancy, poor stream, incomplete emptying
May also have symptoms of urge or stress incontinence
What is the Rx of overflow incontinence?
Exclude/Rx obstructive cause
BPH – alpha-blockers, 5a-reductase inhibitors
Surgical – TURP for BPH, tumour excision, stricture division
Medication review & non-pharmacological
Anticholinergics, TCA, Sedatives – anticholinergic effects, Ca channel blockers
Constipation/faecal loading
Discourage excessive abdominal straining
Confirm diagnosis with urodynamic testing
Clean intermittent self-catheterisation
What is functional incontinence?
Chronic physical or cognitive impairment resulting in loss of urine due to inability access toilet for multiple reasons
What is the Rx of functional incontinence?
- Exclude & Rx organic causes
UTI
Constipation/faecal impaction
Medication review – sedatives - Environmental & mobility Improve access to toilet – location/path, call bells, carer assistance, bed pans/bottles/commode
Manage immobility – i.e. walking aids
Manage dexterity – i.e. modify clothing
Manage cognitive impairment – prompted or timed voids, clearly identified toilet
What are some transient/reversible causes of incontinence in the elderly?
DIAPERS
1. Delirium
2. Infection – urinary
3. Atrophic vaginitis
4. Pharmacological
5. Excess urine output – diabetes, excess fluid intake, alcohol, caffeine
6. Restricted mobility – sedation, access to toilet, physical impairment
Stool impaction – increased external pressure on from full rectum
What drugs are associated with incontinence?
Associated with constipation (external pressure on bladder) - Ca blockers, opioids)
Affect bladder contractility – cholinergics, anticholinesterases, SSRIs, TCA, antipsychotics, Ca blockers, opioids
Affect sphincter function – alpha blockers
Diuresis/Fluid retention – diuretics, alcohol, caffeine, Ca blockers
What is the neurological control of voiding/storage process?
- Somatic/voluntary (external sphincter, pelvic floor muscles) - pudendal (S2-S4)
- Voiding - parasympathetic - pelvic (S2-S4)
- Storage - sympathetic - hypogastric (T12-L2)
