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Y4: Geriatric Medicine > Continence (Faecal/urinary) > Flashcards

Continence (Faecal/urinary) Flashcards

1
Q

Describe the urinary flow rate in men and women?

A
  • Men
    • 20-25ml/s
  • Women
    • 25-30ml/s
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2
Q

Describe the capacity of the bladder?

A
  • 300-550ml
    • The bladder signals for the person . to micturate at around 400ml
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3
Q

Describe the regulation of micturition?

A
  • Parasympathetic stimulation from pelvic nerve (S2-4) causes detrusor muscle to contract which increases the intra-vesicular pressure
  • Pontine micturition centre inhibit Onuf’s nucleus which reduces sympathetic stimulation
  • Conscious relaxation of the external urethral sphincter allows urine to pass
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4
Q

Describe the differences in the end part of micturition between men and women?

A
  • Female
    • Assisted by gravity
  • Men
    • Bulbospongiosus contractions expel the urine
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5
Q

What is urinary incontinence?

A
  • Any involuntary leakage of urine
  • More common in women
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6
Q

Risk factors for urinary incontinence?

A
  • Childbirth, hysterectomy
  • Obesity, recurrent UTI
  • Smoking, caffeine
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7
Q

Describe the pathophysiology of urinary incontinence?

A
  • As urine accumulates the bladder, the sphincter tone gradually increases
    • But there is no changes in vesical pressure, detrusor pressure or intra-abdominal pressure
  • Normally during micturition, the intravesicular pressure increases as a result of detrusor contraction and the sphincter relaxes, allowing urine to flow
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8
Q

Describe Stress incontinence?

A
  • Passive bladder pressure exceeds the urethral pressure
    • Due to poor pelvis floor support or a weak urethral sphincter
  • Incontinence during coughing, sneezing and exertion
  • Women, esp after childbirth, and sometimes men after prostate surgery
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9
Q

Describe Urge incontinence?

A
  • Due to detrusor over activity
    • Increased bladder pressure which overcomes the urethral sphincter
  • May also be driven by hypersensivite bladder from UTI or bladder stone
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10
Q

Causes of Urge incontinence / detrusor overactivity?

A
  • Idiopathic
  • Neurological conditions
    • Spina bifida
    • Multiple sclerosis
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11
Q

Describe continual urinary incontinence?

A
  • Suggestive of fistula between bladder and vagina (vesicovaginal)
  • Can occur with:
    • Gynaecological surgery or malignancy
    • Post-radiotherapy
    • Prolonged obstructed labour
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12
Q

Describe Overflow incontinence?

A
  • Occurs when the bladder becomes chronically overdistended
  • Can lead to AKI (high-pressure chronic urinary retention)
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13
Q

Causes of overflow incontinence?

A
  • Bladder neck obstruction
  • Bengin prostatic enlargement
  • Failure of detrusor muscle (atonic bladder)
    • Damage of pelvic nerves
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14
Q

Describe Functional incontinence?

A

When they know they need to go to the toilet but can’t get there in time

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15
Q

Describe passive urinary incontinence?

A
  • Physically they could control the bladder
  • But cognition impairs their ability to do so
    • Micturition is learned behaviour
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16
Q

Management for functional and passive urinary incontinence?

A
  • Physiotherapy / occupational therapy
  • Timed holding of urine
  • Pads
17
Q

Describe post-micturition dribble?

A
  • Due to a small . amount of urine being trapped in the U-bend of the bulbar urethra
  • It then leaks out when the patient moves
  • More pronounced if urethral diverticulum or stricture
  • Can occur in women with a urethral diverticulum
18
Q

What can a post-micturition dribble mimic in women?

A

Stress incontinence

19
Q

Name some of the clinical features of urinary incontinence?

A
  • Encouraged to keep a voiding diary
    • Volume, frequency, associated features
  • Neurological assessment
  • Rectal examination
    • Assess prostate and for faecal impaction
  • Geniital examination
    • Men: phimosis, paraphimosis
    • Women: vaginal mucosal atrophy, cystoceles
20
Q

Describe some investigations into urinary incontinence?

A
  • Urinalysis and culture
  • Ultrasound abdomen
    • May show retained urine with overflow incontinence (>100mL post micturition)
  • CT scan and cystoscopy
    • Patients with continual incontinence who are suspected of having a fistula
21
Q

Describe the management of stress urinary incontience?

A

Physiotherapy

22
Q

Describe the management of urge urinary incontience?

A
  • Bladder retraining
    • Teaching patients to hold more urine voluntarility in the bladder
    • Assisted with anticholinergic medication
23
Q

Describe the management of urinary incontience secondary to fistula formation?

A

Surgery

24
Q

Describe the management of overflow urinary incontience due to bladder obstruction?

A
  • Surgically OR
  • Long term catheterisation (intermittet/continuous)
25
Q

Describe the management of urinary incontience due to neurological diseases?

A

Intermittent self catheterisation .

26
Q

How does urinary incontience usually come to attention in the elderly?

A

When it causes a social or hygiene problem

27
Q

Describe the assessment and management of urinary incontinence in old age?

A
28
Q

Describe normal faecal continence?

A
  • Depends on:
    • Maintenance of anorectal angle
    • Tonic contraction of the external anal sphincters
  • On defacation, there is relaxation of the anorectal muscles, increased intra-abdominal pressure from the Valsalva manoeuvre, contraction of abdominal muscles and relaxation of the anal sphincters
29
Q

Name some causes of faecal incontinence?

A
  • Childbirth, hysterectomy
  • Diarrhoea/constipation
  • Faecal impaction
  • Haemorrhoids, rectal prolapse, Crohns disease
  • Cauda equina, dementia
30
Q

High risk patients for faecal incontinence?

A
  • Frail older people
  • Women after childbirth
  • Thoses with severe cognitive impairment
31
Q

Investigations for faecal incontinence?

A
  • History & examination
  • Assess stools using Bristol stool chart
  • Endoanal ultrasound
    • Defines integrity of the anal sphincters
  • MR proctography
32
Q

Describe the management of faecal incontinence?

A
  • Diarrhoea
    • Loperamide, codeine phosphate
  • Proper diet and fluid intake
  • Pelvis floor exercises
  • Bowel retraining techniques
  • Surgery for sphincter defects
33
Q

Describe the surgical approach to anal sphincter repairs?

A
  • Sacral nerve stimulation
    • View to insert permanent stimulator
  • If unsuccessful:
    • Insert artificial anal sphincter

Y4: Geriatric Medicine (9 decks)

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