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Geriatrics > Continence > Flashcards

Continence Flashcards

1
Q

What are the types of urinary incontinence?

A 
Urge
Overflow
Stress
Bladder outlet obstruction 
Mixed 
Fistulae 
Functional
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2
Q

What are the voiding (obstructive) lower urinary tract symptoms?

A 
Hesitancy 
Straining 
Weak flow 
Terminal dribbling 
Prolonged voiding 
Retention 
Overflow incontinence 
Pain
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3
Q

What are the storage (irritative) lower urinary tract symptoms?

A 
Frequency 
Urgency 
Nocturia 
Urge incontinence 
Small voided volume
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4
Q

How would you examine a patient?

A

Cardiorespiratory - assess for respiratory/heart failure

Abdomen - palpate for masses, enlarged kidneys, distended bladder, DRE exam

Mental state - perform a cognitive assessment

Pelvis - check for vaginal trophy or prolapse, assess pelvic floor muscle strength, assess for stress incontinence

Neurological - assess gait, look for clues to neurological diagnosis, check dorsiflexion of the toe, check perineal sensation, sensation of the sole, posterior aspect of the thigh

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5
Q

What is urge incontinence?

A

Failure of the bladder to store urine because of high bladder pressure

as seen in overactive bladder syndrome

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6
Q

What is stress incontinence?

A

weakness of the urinary outlet

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7
Q

What is mixed incontinence?

A

A combination of stress incontinence and urge incontinence

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8
Q

What is bladder outlet obstruction?

A

A bladder that is overfull and overflows

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9
Q

What are fistulae?

A

Abnormal communications of urinary tract

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10
Q

What is functional incontinence?

A

incontinence due to more general impairment

for example - cognitive, functional, affective

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11
Q

What are the key points to taking a history?

A

Consider lower urinary tract symptoms - storage or voiding

Determine fluid intake, timing and types - caffeine, alcohol

Systems review - diabetes/CKD

Obstetric history in women

Assess effect on quality of life

Medication history

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12
Q

What are the red flag symptoms?

A

Pain on micturition
Haematuria
Prolapse beyond the introits
Suspicion of prostate cancer

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13
Q

What effect does alcohol have on urinary incontinence?

A

polyuria
frequency
delirium

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14
Q

What effect do ACE inhibitors have on urinary incontinence?

A

Cough

Stress incontinence

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15
Q

What effect do anticholinergics have on urinary incontinence ?

A

Urinary retention

Overflow

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16
Q

What effect do diuretics have on urinary incontinence?

A

Polyuria
Frequency
Urgency

17
Q

What effect do opiates have on urinary incontinence?

A

Delirium
Sedation
Constipation - overflow incontinence
Urinary retention

18
Q

What effect do TCAs have on urinary incontinence?

A

Urinary retention

Overflow

19
Q

What investigations should be carried out to investigate incontinence?

A
  • Urinalysis
  • MSU for microscopy, culture and sensitivity
  • Post-void bladder scan
  • Frequency volume chart (bladder diary)

More complex investigations

  • uroflowmetrey
  • video urodynamics
  • ambulatory urodynamics
20
Q

What are the causes of stress incontinence?

A

instrumentation during childbirth and/or pelvic floor damage

Vaginal prolapse

Post-prostatectomy in men

21
Q

How should stress incontinence be managed?

A

lifestyle measures - smoking cessation, weight loss, reduced caffeine/alcohol intake

Pelvic floor exercises - 6/12 first line

Medication - duloxetine (SNRI) - limited evidence

Surgery

  • mid-urethral sling insertion
  • colposuspension
  • bulking agent injections
22
Q

What are the causes of overactive bladder?

A

Idiopathic - most common

Neurogenic - parkinsons, MS, stroke or spinal cord injury

Infective - UTI

Bladder outlet obstruction

23
Q

How should overactive bladder be managed?

A

Lifestyle measures - weight loss, reduced caffeine/alcohol intake, time drinks - not after 8pm, manage constipation

Behavioural therapy - bladder training = 1st line

Pelvic floor exercises

Continence advisors

Medication - anticholinergic, B3 adrenoceptor agonists

Intravagnial oestrogen

Intradetrusor botox injections

Sacral nerve stimulation

24
Q

What are the causes bladder outlet obstruction?

A 
phimosis 
stricture 
sexually transmitted diseases
trauma
blood clot 
calculi 
BPH
cancer of prostate or bladder
cancer of cervix or colon
25
Q

What is the definition of polyuria?

?mls in 24 hrs

A

> 2500mls in 24 hours

26
Q

What is retention?

?mls after voiding

A

> 100mls after voiding

27
Q

When do you think about catheterising a patient?

A

250-300mls

28
Q

How is frequency described?

?times per day

A

> 8 times a day

29
Q

How is nocturia described?

? times per night

A

> 3 times a night

30
Q

How do calcium channel blockers effect continence?

A

decrease smooth muscle contractility

31
Q

What are the causes of transient incontinence?

DIAPPERS

A
  • Delirium
  • Infection especially UTI
  • Atrophy – vaginal
  • Pharmacological
  • Psychological – delirium, depression
  • Excess urine output – excess intake, DM etc.
  • Restricted mobility
  • Stool impaction – constipation
32
Q

What are the systemic causes of continence problems?

A
  • Multiple sclerosis
  • Stroke
  • Dementia
  • Congestive Heart Failure
  • Parkinson’s
  • Diabetes
  • Musculoskeletal disease (mobility)
  • Chronic lung disease
33
Q

What are the consequences of continence problems?

A
  • Decreased QofL
  • Skin infection
  • Falls
  • Isolation
  • Care home admission
  • Depression
  • Pressure ulcers
34
Q

What are the most common causes of incontinence in men/women?

A

damaged periurethral striate muscle in women

prostatic hypertrophy in men

35
Q

How should bladder outlet obstruction be managed?

1 - lifestyle
2 - MDT
3 - medical
4 - surgical

A 
Lifestyle
 •	Reduce evening fluid intake
•	Less caffeine, alcohol
•	Weight reduction
•	Manage constipation

MDT
• Continence advice
• Behavioural therapy – bladder retraining
• Pelvic floor exercises

Medical
• Doxazosin for BPH, or finasteride
• May need to treat OAB at same time

Surgical
• Depends on cause, most likely TURP if BPH etc.

36
Q

What are the possible causes of faecal incontinence?

A
  • Faecal loading
  • Diarrhoea i.e. infectious, IBS, IBD i.e. Crohn’s, UC.
  • Lower GI cancer?
  • Rectal prolapse, 3rd degree haemorrhoids
  • Acute anal sphincter injury
  • Neuro i.e. acute disc prolapse, cauda equina syndrome
37
Q

What are the management options?

lots

A
  • Encourage good fluid intake
  • Ensure good nutrient intake and balanced diet
  • Consider a food and fluid diary
  • Do an anogenital examination
  • Screen for malnutrition
  • Encourage good bowel habits
  • May require surgery i.e. stoma
38
Q

What is the first line medication for constipation?

A

sodium docusate - stool softener and stimulant

39
Q

What other meds can be used to manage constipation?

A
  • Lactulose = stool softener
  • Senna = osmotic laxative
  • Glycerin suppositories to soften stools
  • Microlax enemas to move soft stools
  • Phosphate enemas if the stool is high up

Geriatrics (17 decks)

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