Continence

Question 1

Two types of lower urinary tract problems and their sx

Answer 1

Storage problems

• Frequency
• Urgency
• Nocturia

Voiding problems (used to be known as prostatism)

• Poor stream
• Intermittent stream
• Hesitency
• Straining to void
• Terminal dribbling

Question 2

Stress incontinence definition causes exacerbaters and general treatment

Answer 2

Definition: incontinence caused by increased abdo pp

Causes: anything that causes weak pelvic floor (vaginal atrophy (menopause) ergo age, child birth +/- assisted, pelvic surgery, high bmi)

Exacerbaters: coughing, sneezing ergo smoking coughs colds etc.

General treatment: pelvic floor exercised –> duloxetine (drug) –> surgery (TVT)

Question 3

Overactive bladder definition, risk factors, diagnosis and breif management

Answer 3

Definition: Detruser contracts before bladder is full, can be 1ary or 2ary to BPH and neuro condition (parkinsons)

Risk factors: obs, age, constipation, obesity

Diagnosis: bladder diary, if 100 mls every hour and several times in the night most likely overactive bladder

Management:

• Lifestyle: dec caffiene, wgt, evening fluids
• Bladder training
  
  • Take longest interval w/out peeing
  • Wake up and go at that point EVERY TIME
  • Slowly increase interval
• Drugs
  
  • Antimuscarinics

Question 4

Voiding problems definition, causes and treatment

Answer 4

Definition: outflow obstruction (assocaited with erectile dysfunction)

Causes: BPH, Ca, tight foreskin, constipation, stone, blood clot

BPH treatement

• Alpha blockers
• 5 alpha reductase inhibitors

Constipation treatment (DO A PR)

• Assess cause: dehydration, drugs, nutrition, neuro, obstruction, endocrine, depression, iatrogenic
• Treat cause
• Drugs: buking agents e.g. bran, osmotic laxatives, stimulant laxatives

Question 5

Taking a continence history

Answer 5

Want to find out is it stress incontinence, overactive bladder or voiding issues

Age + gender

PC: Peeing when increase abdo pp/ frequency and urgency/voiding symptoms?

HPC:

• SOCRATES
• bladder diary? Urgency + frequency
• Leakage with pp?
• Voiding sx?
• Constipated?
• If concerned about cancer ask those question, haematuria, wgt loss, night sweats, lethargy

PMHx:

• Prostate issues?
• Constipation
• ObsHx
• Prolapse
• Cough/ colds

DHx:

• Causes of constipation

PSHx: Pelvic surgery

SHx

• Smoking
• Alcohol
• Caffiene

FHX

• Prostate trouble
• Urinary problems

ICE

Question 6

Continence investigations/functional assessments

Answer 6

Bladder and fluid diary (overactive bladder)

Bimanual (prolapse)

Prostate markers (PSA)

DRE (prostate + constipatiomn)

Investigate any possible 2ary causes e.g. parkinsons

Urodynamics