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Specialites Summary > Continence > Flashcards

Continence Flashcards

1
Q

What is incontinence linked with?

A

Functional decline
Nursing home placement
Death
Socially and psychologically challenging

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2
Q

Definition of incontinence

A

Unintentional passing of urine

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3
Q

Types of incontinence

A

Stress incontinence
Urge incontinence (overactive bladder)
Overflow incontinence

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4
Q

What is mixed incontinence?

A

Stress incontinence and urge incontinence

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5
Q

Bladder control is dependent on….

A 
Functioning bladder
Functioning sphincters
cognition 
mobility 
dexterity
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6
Q

Bladder changes with age

A 
Vaginal atrophy
Decreased bladder capacity 
Increased residual volume 
Prostate hypertrophy 
Increased urine production at night
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7
Q

Reversible factors possibly related to incontinence

A 
Polydipsia 
Medications
UTI
Prolapse
Delirium
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8
Q

Co morbidities associated with incontinence

A 
Decreased mobility
BOO
Constipation 
Stroke
Spinal cord pathology 
Cognitive impairment
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9
Q

Functions of the bladder

A 
Urine storing
- detrusor muscle relaxation 
- sphincter contraction 
Voluntary voiding
- relaxation of external sphincter 
- involuntary relaxation of internal sphincter
- contraction of bladder
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10
Q

Involuntary muscles of the bladder

A

Detrusor (smooth muscle)

Internal urethral sphincter (smooth muscle)

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11
Q

Voluntary muscles of the bladder

A

External urethral sphincter (voluntary)

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12
Q

Innervation of the bladder

A

parasympathetic
- S2-S4 = detrusor muscle contraction = urine
Sympathetic
- T10-L2 = detrusor muscle relaxation
- T10 - S2 = internal sphincter contraction
Motor/somatic
- S2-4 external sphincter contraction

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13
Q

Control of urination

A

Can have voluntary control over stretch reflex mechanism

  • pontine micturition centre (blocks parasympathetic actions)
  • frontal cortex exerts overall control
  • caudal part of spinal cord
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14
Q

Causes of overflow incontinence

A

Urethral blockage OR

bladder unable to empty properly

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15
Q

Pathology of stress incontinence

A

Relaxed pelvic floor

Increased intraabdominal pressure

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16
Q

Causes of urge incontinence

A

Bladder oversensitivity from infection
Neurological disorders e.g. strokes
Bladder stones

17
Q

Triggers of stress incontinence

A

Increased intra abdominal pressures

  • coughing
  • sneezing
  • laughing
  • standing up
18
Q

Stress incontinence is common in who?

A

Women

  • have had children
  • after menopause
19
Q

What is urge incontinence?

A

Incontinence associated with the sudden urge to pass urine (and cannot be delayed)

20
Q

Symptoms of overflow incontinence

A

Hesitancy
Reduced stream/poor urine flow
post micturition dribbling
Double voiding

21
Q

Two types of urinary system disease

A

Bladder outlet over activity

Bladder outlet under activity

22
Q

Extrinsic causes of incontinence

A 
Physical state and co morbidities
Decreased mobility 
Confusion (delirium/dementia)
Drinking too much/at wrong time 
Diuretics 
Constipation 
Home / social circumstances
23
Q

Intrinsic causes of incontinence

A

Bladder outlet

  • too weak = stress incontinence
  • too strong = urinary retention + over flow incontinence

Bladder muscle

  • too strong = urge incontinence
  • too weak = neuropathic bladder
24
Q

Investigations of incontinence

A 
Abdominal exam 
PV
- strength of pelvic floor muscles
- vaginal redness/dryness
- Prolapse 
PR 
- anal one (neuropathic problems)
- constipation 
Urinalysis / MSSU 
Bladder scan (residual volume post void)
Urodynamics 
- cystometry 
- uroflowmetry
25
Q

Management of incontinence

A 
Weight control 
fluid control 
reduce bladder irritants 
Pelvic floor training exercises 
Bladder retaining 
Pads/urinals 
Surgery 
- colposupension 
- TVT tape
26
Q

Bladder irritants

A

Caffeine
Fruit juice
Alcohol
Stop unnecessary drugs

27
Q

AIDs for pelvic floor muscle exercises

A

Biofeedback
Vaginal cones (adding extra weight)
electrical stimulation

28
Q

Specific treatment for urge incontinence

A 
Bladder retaining programme 
Prompted, regular toileting
Anticholinergics
Beta-3-adrenoreceptor agonist 
Botulinium toxin 
Sacral nerve stimulation
29
Q

Specific treatment for overflow incontinence

A

Relieve the obstruction

  • prostatic hypertrophy/tumour
    • anti-androgen
    • TURP
  • Relax sphincter
    • alpha blocker
  • bypass obstruction (catheter)
30
Q

What do antimuscarinics do?

A

Relax detrusor

31
Q

What do beta-3-receptor agonists do?

A

Relax detrusor

32
Q

What do alpha blockers do?

A

Relax sphincter, bladder neck

33
Q

What do anti androgen drugs do?

A

Shrink the prostate

34
Q

What is neuropathic bladder secondary to?

A

Neurological disease e.g. MS or stroke

Prolonged catheterisation

35
Q

What does a neuropathic bladder result in?

A

No awareness of bladder filing resulting in overflow incontinence

36
Q

Only effective treatment for neuropathic bladder

A

Catheterisation

37
Q

Criteria for urinary catheters

A

Symptomatic urinary retention
BOO, otherwise unable to clear
Undue stress caused by alternative management in elderly/frail/dying

38
Q

Indications for incontinence referral to specialist

A

Failure of initial management (max 3 months)
Vesico-vaginal fistula
Palpable bladder after micturition or confirmed large residual volume
Disease of CNS
Certain gynae conditions e.g. fibroids, rectocele
Severe benign prostatic hypertrophy or prostatic carcinoma
Previous surgery for continence problems
Diagnosis not been made
Faecal incontinence

39
Q

Measures to promote independence if all else fails

A 
Incontinence pads
Urosheaths
Intermittent catheterisation 
Long term urinary catheter
Suprapubic catheter

Specialites Summary (15 decks)

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