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Physio in Specific Groups > Continence (Part 1) > Flashcards

Continence (Part 1) Flashcards

1
Q

What is incontinence?

A

A condition where involuntary loss of urine is a social or hygienic problem and is objectively demonstrable

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2
Q

What is required in order to remain continent?

A
  • KNOW you have to go to the toilet
  • Know WHERE the toilet is located
  • PHYSICALLY be able to get there
  • UNDRESS
  • Do all this in TIME
  • Or you have an “accident”
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3
Q

Why is continence important?

A
  • Self-esteem, function and independence
  • Personal hygiene
  • Ongoing participation in physical activity
  • QOL (sleep, travel, social & family interaction)
  • Reduced risk of falling
  • Lower personal and community cost of living
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4
Q

What are the most common reasons for nursing home admission?

A
  • Faecal incontinence (most common)
  • Urinary incontinence
  • Poor mobility
  • Dementia
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5
Q

What are the critical factors that shift a client’s care options from community based care to residential care?

A
  • Dementia/cognitive function
  • Mobility
  • Incontinence
  • Support networks
  • Carer stress/ability to cope
  • Functional ability and ADLs
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6
Q

Incontinence commonly affects female athletes of which sports?

A
  • Trampoline jumping (80%)
  • Cross-country skiers & runners (45%)
  • Olympic track & field (35%)
  • High impact sports
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7
Q

What are the 6 Rs of clinical effectiveness?

A
  • Right person
  • Right thing
  • Right way
  • Right place
  • Right time
  • Right results
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8
Q

What does evidence show about outcomes for incontinence when treated by physio?

A
  • Strong evidence for good outcomes for stress, urge & mixed incontinence if treated by continence/PF physios
  • But not generalisable to other HPs
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9
Q

What does evidence show regarding self-help PF exercises?

A
  • May not be effective
  • Causes pt to feel demotivated
  • Excludes opportunity for effective management
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10
Q

What does evidence show regarding use of RTUS for PF?

A
  • Not diagnostic tool for PFM weakness or strength
  • Provides no info on tone, defects, size of hiatus
  • Does not qualify the user to treat PFD
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11
Q

What are the 3 sections to the levator ani (deep PF muscle layers)?

A
  • Pubococcygeus
  • Iliococcygeus
  • Ischiococcygeus
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12
Q

Which muscle is most important for voluntary control of the urethral & anal sphincter?

A

Pubococcygeus, 3 bands of fibres:

  • Pubovaginalis
  • Puborectalis
  • Pubococcygeus proper
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13
Q

What is the function of the levator ani?

A
  • Maintains high position of the bladder neck
  • Augments bladder neck support during coughing
  • Relaxes during voicing to change position of the bladder neck allowing micturition to occur
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14
Q

What are the 2 different types of PF muscles & their functions?

A
  • Slow twitch: Constantly contracting during mobilisation to hold pelvic organs in position
  • Fast twitch: Sustain short, sharp contractions
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15
Q

How is the lower urinary tract innervated?

A

3 sets of nerves:

  • Pelvic PS nerves from S2-4 (bladder excitation & urethra relaxation)
  • Lumbar sympathetic nerves (bladder inhibition & bladder neck/urethral excitation)
  • Pudendal nerves (PF)
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16
Q

How does sympathetic control effect the bladder?

A
  • Allows the bladder to fill

- Release of NE relaxes smooth muscles in bladder wall & excites smooth muscles in sphincter valve

17
Q

How does parasympathetic control effect the bladder?

A
  • Empties the bladder
  • Release of ACh relaxes smooth muscles in the sphincter valve & excites smooth muscles in the bladder wall
  • Forces contents of bladder out
18
Q

What are the normal voiding mechanisms?

A
  • Brain sends nerve signals telling muscles to hold/expel urine
  • Nerves send signals to the brain indicating when bladder is full or empty
19
Q

What are the reversible causes of incontinence (DIAPPERS)?

A
  • D: Delirium/dementia
  • I: Inections
  • A: Atrophic vaginitis
  • P: Psychological causes (esp. depression)
  • P: Pharmaceutical agents
  • E: Endocrine conditions (e.g. diabetes)
  • R: Restricted mobility
  • S: Stool impaction
20
Q

What are the surgical causes of incontinence?

A
  • Pelvic surgery
  • Pelvic irradiation
  • TURP/prostatectomy
  • THR / # NOF
  • Hernia repair
  • Abdominal surgery
21
Q

What are the medical causes of incontinence?

A
  • Diabetes
  • Neuro conditions (stroke, SCI etc.)
  • Medications
  • Chronic bowel disease
  • Chronic cough
  • Dementia
22
Q

What are the biomechanics & environmental causes of incontinence?

A
  • Increasing age
  • Obesity
  • COPD, smoker, hayfever
  • Acute/chronic LBP/SIJ pain
  • History of falls
  • Reduced mobility, dexterity, eyesight, cognition
  • Generalized weakness/debility
23
Q

What are the exacerbating factors of incontinence?

A
  • Diet: Low fibre, low fluid intake, caffeine
  • Lifestyle: Obesity, smoking
  • Physical environment: Lighting, distance (trip factor)
24
Q

What age related changes can affect incontinence?

A
  • Nervous system
  • Bladder
  • Urethra
  • Co-morbidities (PD, dementia, COPD etc.)
25
Q

What are the types of incontinence?

A
  • Stress incontinence
  • Urge incontinence
  • Over-active bladder syndrome
  • Overflow incontinence
  • Nocturia/nocturnal enuresis
  • Functional incontinence
  • Faecal incontinence
26
Q

What is stress incontinence & the implications for physio?

A
  • Involuntary loss of urine (usually small amounts) with increases in intra-abdominal pressure
  • e.g. cough, laugh, exercise sport, changing position
  • May be inhibited from doing generalised exercise program or specific abdominal exercises
27
Q

What is urge incontinence & the implications for physio?

A
  • Occurs due to uncontrollable urge to go to the toilet
  • Sensory: an outside stimulus causes need to urinate
  • Motor: bladder muscle contracts for no apparent reason (detrusor instability)
  • May be reluctant to do generalised fitness or leave home for fear of not making it to a toilet
28
Q

What is overactive bladder syndrome (OAB) & the implications for physio?

A
  • Includes urgency, frequency (day & night), nocturia, +/- wetting
  • Slow insidious onset over many years
  • May be reluctant to do generalised fitness or leave home for fear of not making it to a toilet
29
Q

What is overflow incontinence & the implications for physio?

A
  • Occurs due to incomplete emptying of bladder
  • May develop insidiously
  • Commonly with neuro problems
  • May be caused by trauma
  • Won’t want to stray too far from a toilet, may
    not want to do abdominal exercises if sore
30
Q

What is nocturia?

A
  • Waking up to go to the toilet more than once per night
  • Can be due to nocturnal frequency or nocturnal polyuria
  • May have day problems as well
31
Q

What is nocturnal enuresis?

A
  • Involuntary loss of urine occurring during sleep
  • Can be due to medication, small bladder capacity, decreased ADH and fluid intake
  • Common in children but also found in older adults
32
Q

What is functional incontinence?

A
  • Associated with inability to toilet because of cognitive/physical impairment or environmental barriers
33
Q

What are other lower urinary tract symptoms?

A
  • Frequency
  • Voiding difficulties (poor/slow stream, dribble)
  • Haematuria
  • Dysuria

Physio in Specific Groups (12 decks)

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