Continence

Question 1

What needs to be recorded on a 3 day bladder diary?

Answer 1

• Record each day the time you get up and the time you go to bed
• Measurements of each void in ml recorded on the chart to nearest hour (some individuals may void more than once per hour)
• Record of degree of urgency for each void (0 = no urgency, 1, 2, 3 = very urgent)
• Record of all wet episodes and degree of wetness. The degree of wetness could be subjective (dry, damp/dribble, wet/stream, soaked/flood) or by pad weighing
• What you were doing when you leak – you may want some individuals to record this information
• Record of pad/underwear changes

Question 2

Describe the important aspects of an incontinence examination.

Answer 2

• Pelvic exam (asked to cough to see if any urine leaks)
• Assessment of pelvic floor muscles
• Check health of prostate (DRE)
• Urine dip
• Residual urine test

Question 3

How do you identify a urinary tract infection?

Answer 3

• A strong, persistent urge to urinate.
• A burning sensation when urinating.
• Passing frequent, small amounts of urine.
• Urine that appears cloudy.
• Urine that appears red, bright pink or cola-colored — a sign of blood in the urine.

Question 4

Describe how to interpret a bladder scan.

Answer 4

There is no consensus regarding normal and abnormal post void residual urine. It is generally considered that a PVR less than 50mL is adequate bladder emptying, while over 200mL is thought to be inadequate

Question 5

Describe some common urine dipstick misconceptions.

Answer 5

• Visual inspection of urine clarity is not helpful in diagnosing UTI in women
• Foul-smelling urine is an unreliable indicator of infection in catheterized patients
• UTI is not a laboratory-defined diagnosis. Diagnosis should be based on clinical symptoms whenever possible, and confirmed by positive urine microscopy and culture
• Even if both leukocyte esterase AND nitrite analyses are positive, the sensitivity for bacteriuria was only 48% among elderly nursing home residents, indicating the need to correlate with clinical symptoms that suggest a UTI

Question 6

Describe some non-pharmacological management techniques of incontinence.

Answer 6

These include lifestyle interventions such as adjustment of fluid intake and weight loss, physical and behavioural therapies (pelvic floor muscle training, electrical stimulation, vaginal cones and bladder training programmes) and occasionally containment devices.

Question 7

Name some containment products used to keep a person continent.

Answer 7

Absorbent pads or urine collecting devices (sheaths, hand held urinals, faecal collectors)

Question 8

Describe some pharmacological management techniques of incontinence.

Answer 8

Several different pharmacological actions are potentially useful depending on the underlying cause of the incontinence:

a) Detrusor instability (DI) responds to drugs reducing bladder contractility: Anticholinergic agents, e.g. oxybutynin and tolterodine, act at postganglionic parasympathetic cholinergic receptor sites on the detrusor muscle, reducing the strength of the detrusor contraction.
b) Tricyclic antidepressants, e.g. imipramine, have anticholinergic effects, block presynaptic uptake of amine neurotransmitters and directly inhibit detrusor muscle.
c) Alpha-adrenergic antagonists may have a role to play by dual actions on bladder overactivity (due to altered receptor function) and by reducing outlet resistance.
d) Genuine stress incontinence (GSI) may be treated using alpha-adrenergic agonists, e.g. phenylpropanolamine, to increase outlet resistance by stimulating smooth muscle of the urethra and bladder neck.

Question 9

Describe the impact of incontinence on a person

Answer 9

If incontinence is not managed well, the person with incontinence may experience feelings of rejection, social isolation, dependency, loss of control and may also develop problems with their body image.