Continence Flashcards
Most useful investigation for mixed incontinence
Post void bladder scan
What circumstances would you refer the patient onto cystoscopy?
Painless haematuria
Bladder cancer
Polyps, bladder cancer?- recurrent UTIs
When would you do a urine dipstick in over 65?
IgA nephropathy
Vasculitis
What medication for urge incontinence should be avoided in elderly people?
Oxybutynin (antimuscarininc)
Impairs cognition in patients with dementia
Safer alternatives are tolterodine and Mirabegron
What investigations are mandatory when doing a complete continence examination?
- Review of bladder and bowel diary
- Abdominal examination
- Urine dipstick and MSU
- PR- examination including prostate assessment in a male
- External genitalia review particularly looking for atrophic vaginitis in females
- A post micturition bladder scan
Is incontinence part of the normal aging process?
NO
What is the most common cause of faecal incontinence?
Faecal impaction with overflow diarrhoea
(Remember lady on Naseby- bowel obstruction, went about 7 times a day but small and yellow watery stools)
How can faecal impaction and constipation be life threatening?
Stercoral perforation
Ischaemic bowel
Symptoms, investigation, conservative and pharmacological management of stress incontinence
Symptoms
- Leakage with coughing, sneezing, laughing.
Inx
- Vaginal examination
- Bladder diary
- Pad test
- Urodynamic studies
- Cystoscopy
Conservative
- Kegel exercises for 3 months
- Weight loss
- Avoid irritants
Pharmacological
- Topical oestrogen
- Alpha adrenergic agonists
- Duloxetine- SNRI
Surgical
- Colposuspension
- Rectus fascial sling
Symptoms, investigation, conservative and pharmacological management of urge incontinence
Symptoms
- Sudden urge to urinate
- Frequency, nocturia and urgency
Inx
- Bladder diary
- Urinalysis
- Urodynamic studies
- Cystoscopy
- Cystometry
Conservative
- Bladder training
- Reduce irritants
Drugs
- Antimuscarinincs (avoid in older people)- oxybutynin, tolterodine
- Beta 3 agonists- Mirabegron
Surgery
- Boutulinum toxins
Symptoms, investigation, conservative and pharmacological management of overflow incontinence
Symptoms
From detrusor underactivity (MS) or bladder outlet obstruction- fibroids
- Incomplete bladder emptying
- Dribbling
Inx
- Post-void residual volume bladder scan
- Urodynamic studies
Conservative
- Catheters
- Bladder training
Drugs
- Tamsulosisn (alpha blockers)
- Cholinergic agents- bethanechol for underactive bladder
Symptoms, investigation, conservative and pharmacological management of functional incontinence
Symptoms
- Seen in dementia, frailty or mobility issues
- Physical, cognitive limitations
Inx
- Functional assessment
- Urinalysis
- Bladder diary
Conservative
- Assistance with toilet
- Scheduled voiding
- Modifications to environment
Drugs
- Anticholinergics in dementia
