Continence Flashcards
F:M Incontinence issues
2:1
Types of urinary incontience
Stress incontinence Urge incontinence Mixed incontinence BOO = Bladder outlet obstruction (Bladder overfills + overflows) Fistulae Functional incontinence
Voiding Sx (8)
Hesitancy Straining Weak flow Terminal dribbling Prolonged voiding Retention Overflow incontinence Pain
Storage Sx (5)
Frequency Urgency Nocturia Urge incontinence Small voided volume
Key Hx points incontinence
LUTS - voiding or storage Determined fl intake, timings + types SR incl cardio, neuro, bowel habits DM/CKD Sx PD + incontience Obstetric Hx Assess the effect on QOL ENviro - toilet, mobility Med Hx UTI Hx
Red flag Sx incontinence (4)
Pain on micturition
Haematuria
Prolapse beyond introitus
Suspicion prostate Ca
O/E incontinence
Cardio/resp MMSE Abdo - distended bladder, enlarged kidney, DRE Vaginal atrophy/prolapse Pelvic floor mm strength Stress incontinence - ask pt to cough Assess gait
Meds + urinary incontinence - alcohol SE
polyuria
frequency
delirium
Meds + urinary incontinence - ACEi SE (2)
Cough
+ stress incontinence
Meds + urinary incontinence - Anticholinergics (2)
Urinary retention
Overflow
Meds + urinary incontinence - diuretics (3)
Polyuria
Frequency
Urgency
Meds + urinary incontinence - opiates (4)
Delirium
Sedation
Constipation
Urinary retention
Meds + urinary incontinence - TCA (2)
Urinary retention
Overflow
Ix incontinence (simple) (4)
Urinalysis
MSU - culture, microscopy, sensitivity
Post void bladder scan
freq vol chart (bladder diary)
Ix incontience (more complex Ix ) (4)
Uroflowmetry
Video urodynamics
Ambulatory urodynamics
USS renal tract/CT abdo
Causes of stress incontinence (5)
Instrumental delivery/pelvic floor damage Vaginal prolapse Post prostatectomy Pudendal nn damage 2' to bladder outlet malfunction
Mx stress incontinence (4)
Lifestyle (smoking, W loss, reduce caffiene)
Pelvic floor exercises
Duloextine
Mid-urethral sling insertion
Causes - overactive bladder (5)
Urgency +/- urge incontinence Idiopathic Neurogenic - MS/PD/stroke/SC injury UTI Bladder outlet obstruction
Mx overactive bladder (7)
Lifestyle - W loss, reduce caffiene, reg bowel habit
Bladder retraining
Anticholinergics/ B3 adrenoceptor agonists - mirabegron
Intravaginal O
Intradetrusor botox injection
Sacral nn stimulation
Causes of bladder outlet obstruction (9)
Phimosis Stricture STD Trauma Blood clot Calculi BPH Ca prostate + bladder Cancer cervix + colon
