Continence

Question 1

give 4 types of incontinence and a brief description

Answer 1

• Stress incontinence –small volumes leak during coughing/laughing –most commonly in women
• Urge incontinence – Frequent voiding, often cannot hold urine. Nocturnal incontinence is common. Commonly seen with detrusor overactivity but can occur in obstruction
• Overflow incontinence – Due to urinary retention. Seen with obstructive symptoms in men with enlarged prostates
• Functional incontinence – Often due to cognitive impairment or behavioural problems

Question 2

what are important aspects of a continence history

Answer 2

• how people void
• frequency
• symptoms
• oral intake
• types of drinks consumed
• bowel habit
• full drug hx

Question 3

what are mandatory components of a complete continence examination

Answer 3

• 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

Question 4

what are non-pharmacological interventions of incontinence

Answer 4

• regular toileting
• switch to decaf
• good bowel habit
• improve oral intake
• pelvic floor exercises
• bladder training

Question 5

if anal tone and sensation is diminished, what does this suggest

Answer 5

spinal cord pathology - manage urgently

Question 6

what are the 2 most common causes of faecal incontinence

Answer 6

1. faecal impaction with overflow diarrhoea
2. neurogenic dysfunction

Question 7

what is a mandatory exmaination in assessment of faecal incontinence

Answer 7

• rectum
• prostate
• anal tone
• sensation
• visual inspection around anus
• stool type if present in anus

Question 8

what is there risk of in patients who are chronically constipated

Answer 8

sterocoral perforation and ischaemic bowel

Question 9

what are the 2 types of faecal impaction

Answer 9

hard and soft stool

Question 10

how is constipation treated

Answer 10

• suppository
• micro enema
• phosphate enema
• high dose macrogol
• stimulant lax
• arachis oil
• manual evacuation

Question 11

how is chronic diarrhoea in the elderly managed

Answer 11

• exclude any underlying cause by bowel imaging and stool culture
• remove causative meds
• red flag symptos
• regular toileting and dietary review
• low dose loperamide trialled then constipating and enema regimes