Bowel and Bladder Issues Flashcards
What are female age related genitourinary changes?
- Vaginal delivery-related changes to support structures of urethra and pelvic organs
- Decreased estrogen causes changes in lower urinary tract
- decreased arterial flow to vagina leads to thinning of vaginal mucosa and perineal skin breakdown which leads to weakened connective tissue structures supporting bladder neck
- decreased arterial blood flow to submucosal vasculature and decreased striated muscle fibers which leads to decreased urethral closure pressure (leads to more UTIs)
What are some male age related genitourinary changes?
during middle age, prostate enlarges (benign prostatic hypertrophy or BPH) which leads to growth of prostatic tissue encroaches on the prostatic urethra
What are age-related genitourinary changes that are shared by both sexes?
- decreased bladder sensation
- decreased detrusor contraction strength which leads to decreased urine flow rate (“appears” to be decreased bladder capacity, which actually doesn’t change)
- increased post-void residual volume
- circadian rhythm changes (decreased diuretic hormone vasopressin which leads to nocturia)
- other renal system changes (loss of renal mass/functional glomeruli, decreased renal blood flow, increased sensitivity to fluid and electrolyte imbalance and decreased drug elimination)
What is urinary incontinence? What does continence require?
involuntary leakage of urine
requires neural coordination between bladder, urethra, and pelvic floor muscles
What is stress urinary incontinence?
What are some risk factors?
occurs with effort or exersion; cough, sneeze, lifting activity, valsalva
- childbirth
- estrogen loss
- radical prostatectomy
- caucasians
- family history/obesity/smoking
- chronic constipation
- pelvic surgery
What is urge urinary incontinence?
What are some risk factors?
A strong desire to pass urine which is difficult to defer without involuntary leakage (i.e can’t get to the toilet in time)
- low bladder compliance
- detrusor over-activity-involuntary bladder contractions (assoc. w/ neuro conditions and pelvic organ prolaspe w/ urethral obstruction)
- benign or malignant prostatic enlargement
- advancing age
- smoking
- hysterectomy
- arthritis
- impaired mobility
What is overflow urinary incontinence?
bladder overly distended causing bladder pressure greater than urethral pressure
from loss of bladder sphincter after surgery or injury
What is functional urinary incontinence?
have normal bladder/urethra function, but have difficulty getting to toilet before urination occurs
common with impaired mobility or cognitive issues
What is mixed urinary incontinence?
combo of all multiple incontinence types
What are the reversible Causes of Urinary incontinence?
Delirium Infection Atrophic urethritis or vaginitis Pharmaceuticals Psychological disorders Endocrine disorders Restriction mobility Stool impaction
(DIAPPERS)
What questions help you screen for UI?
Do you leak urine with laughing, coughing, sneezing, lifting, or exercise?
Do you leak urine on the way to the bathroom?
Do you have to strain to empty your bladder?
Do you feel that your bladder is still not empty after you void?
A yes from any of these questions should result in referral to PCP or specialist for eval
What questions should you ask to identify red flags in urinary incontinence? What are the possible medical concerns for each?
- Was there a sudden onset of incontinence? (infection)
- Did leaking occur after surgery or with medication change? (unexpected side effect of drugs or surgery)
- Is there blood/burning with urine/stool? (infection)
- Is there a change in vaginal discharge? Odor? (infection, atrophic vaginitis)
- Is there difficulty initiating the stream? (acute urinary retention)
- Are there moderate/large amounts of incontinence without warning? (diabetes, heart failure, hyperglycemia)
What medicinal side effects could impact incontinence? What medicines could cause these side effects?
- Reduce urethral pressure (antihypertensives, neuroleptics, and benzodiazepines)
- Impact full bladder emptying (anticholinergics and beta blockers)
- meds that cause constipation
True or False: Patients should always reduce their water intake to combat UI.
False, be cautious to do this as it can lead to constipation from dehydration or UTI and further aggravate the UI
What are the common PT interventions for Urinary Incontinence?
- Focus on pelvic floor muscle exercises (quick contractions, sustained contractions, and contractions during functional activity)
- biofeedback (surface EMG and palpation)
- E-stim (lack of evidence)
- Bladder training (for urge UI) via gradual increase in time intervals between voids using deep breathing or PFM contractions to inhibit bladder (try to delay to every 3-4 hours)
- Lifestyle changes (weight loss, reduction in caffeine consumption, anticholinergic drugs for urge UI)
