Continence

Question 1

What is urinary incontinence?

Answer 1

Involuntary expulsion of urine to a level where it is causing social and or hygeine consequences for the individual and or caregivers

Question 2

Examination needed (5)

Answer 2

Cognition - AMT
Pelvic - vaginal atrophy
Abdo - DRE for constipation rectal mass and anal tone, masses, distended bladder, prostate assessment 
Neuro - gait and sensation
CVS and resp - CCF, CLD

Question 3

Ix needed (6)

Answer 3

Frequency/ volume chart - small and frequent - overactive bladder, >2500ml/day - polyuria, >1/3 of 24h at night- nocturnal polyuria
Urine dip - gluc DM, protein - kid, blood -renal stones, leukocytes and nitrites- uti
Fbc, glucose, ue, calcium
Post void bladder scan - chronic retention of urine
Urodynamics if specialist advice required - normal vol >200ml, 15-20 sec normal flow time, normal Qmax > 20mls/sec

Question 4

Storage sx (6)

Answer 4

urge incontinence, stress incontinence, frequency, urgency, continual urine loss, nocturia

Question 5

Voiding sx (5)

Answer 5

terminal dribbling, post micturition dribbling, hesitancy, intermittent stream, incomplete emptying

Question 6

Other imp things to ask in history

Answer 6

Bowel frequency and function, obsgyne hx, sh - alcohol, smoking, caffeine and fluid intake, pain, dysuria, haematuria, pmh - associated co morbities - ccf, dm, copd, surgical procedures

Question 7

Red flag sx (4)

Answer 7

Painful micturition, haematuria, prolapse beyond introitus, suspicion of prostate cancer

Question 8

Transient reversible causes of incontinence (8)

Answer 8

DIAPPERS
Delirium, Infection - UTI, Atrophy of vagina, Pharmacological, psych - dementia/depression, excess urine output - DM/excess fluid intake, reduced mobility, stool impaction

Question 9

Causes of incontinence (6)

Answer 9

Fistula, functional (incontinence due to general impairment- cognitive, functional, affective), stress, urge, bladder outflow obstruction, medications

Question 10

Stress incontinence causes (6)

Answer 10

Woman - shorter urethra/age/child birth/ post menopause/ obesity, surgery - hysterectomy/ transurethral resection of prostate, age, uti, bladder outflow obstruction, neurological disease

Question 11

Urge incontinence causes (4)

Answer 11

idiopathic, uti, bladder outflow obstruction, neuro - stroke/ms/sc damage/ parkinsons

Question 12

Bladder outlet obstruction causes (9)

Answer 12

phimosis, stricture, trauma, calculi, blood clot, cancer - bladder/prostate, carcinoma - colon/cervix, STD, BPH

Question 13

Medication (8)

Answer 13

Acei - chronic cough can make stress incontinence worse, haloperidol - anticholinergic cause retention, hypnotics - can reduce awareness of sensation, opioids - constipation can cause overflow incontinence, alpha blockers - can cause retention and overflow incontinence, alpha agonists- stress incontinence worse bc relax bladder outlet, calcium channel blockers - reduce smooth muscle contractility, cholinesterase inhibitors - increase bladder contraction