continence Flashcards
what is stress incontinence?
small volumes leak during coughing/laughing –most commonly in women
what is urge incontinence?
Frequent voiding, often cannot hold urine. Nocturnal incontinence is common. Commonly seen with detrusor overactivity but can occur in obstruction.
what is overflow incontinence?
Due to urinary retention. Seen with obstructive symptoms in men with enlarged prostates.
what is functional incontinence?
Often due to cognitive impairment or behavioural problems.
what should be done for a complete continence examination?
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
what interventions can be suggested with urinary incontinence?
switching to decaffeinated drinks, good bowel habit, improving oral intake, regular toileting and pelvic floor exercises and bladder retraining
what pharmacological factors should be considered when intervening in urinary incontinence?
Remember that anticholinergics are not good in older people and oxybutynin whilst good for younger patients is not good for older people.
Many of the drugs used for bladder stabilisation can also cause postural hypotension leading to increased falls.
how does the rectum change with age?
the rectum can become more vacuous and the anal
sphincter can gape due to a number of factors including haemorrhoids and
chronic constipation.
what is the most common cause of faecal incontinence?
faecal impaction with
overflow diarrhoea. This accounts for 50% of faecal incontinence. The second
most common cause is neurogenic dysfunction
what does a diminished anal tone and sensation suggest?
If anal tone and sensation is diminished then this suggests spinal cord
pathology and should be managed urgently.
what is the use of a PR?
mandatory in the assessment of faecal incontinence and
the rectum, the prostate, anal tone and sensation should all be assessed as
well as a visual inspection around the anus.
Stool type should be assessed if in the rectum.
what stool types can suggest impaction with overflow?
smearing, small amount of type 1 stool or copious type 6/7 stool with no sensation of defaecation should raise the suspicion of impaction with overflow
how do urinary retention and faecal loading and constipation correlate?
Behind every full rectum is often a full bladder and if a patient is found to have urinary retention then they MUST have a PR to assess for an impacted rectum and/or a large prostate if male.
how can faecal impaction be deadly?
faecal impaction and constipation can kill, there is a risk of stercoral perforation and ischaemic bowel in those chronically constipated.
how is faecal impaction and constipation managed?
Management should be utilising enemas for rectal loading and stool softeners and stimulants. If stool is hard then stimulants will not help as the stool requires softening. Some enemas will not work if the rectum is loaded with hard stool and will merely fall out.
Manual evacuation is done in difficult cases and the risk of perforation is outweighed by the positive impact on patient symptoms and wellbeing.
In older patients any prescribed drugs that can cause constipation should be co-prescribed with a laxative.
