Continence (Part 1) Flashcards
What is incontinence?
A condition where involuntary loss of urine is a social or hygienic problem and is objectively demonstrable
What is required in order to remain continent?
- 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”
Why is continence important?
- 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
What are the most common reasons for nursing home admission?
- Faecal incontinence (most common)
- Urinary incontinence
- Poor mobility
- Dementia
What are the critical factors that shift a client’s care options from community based care to residential care?
- Dementia/cognitive function
- Mobility
- Incontinence
- Support networks
- Carer stress/ability to cope
- Functional ability and ADLs
Incontinence commonly affects female athletes of which sports?
- Trampoline jumping (80%)
- Cross-country skiers & runners (45%)
- Olympic track & field (35%)
- High impact sports
What are the 6 Rs of clinical effectiveness?
- Right person
- Right thing
- Right way
- Right place
- Right time
- Right results
What does evidence show about outcomes for incontinence when treated by physio?
- Strong evidence for good outcomes for stress, urge & mixed incontinence if treated by continence/PF physios
- But not generalisable to other HPs
What does evidence show regarding self-help PF exercises?
- May not be effective
- Causes pt to feel demotivated
- Excludes opportunity for effective management
What does evidence show regarding use of RTUS for PF?
- 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
What are the 3 sections to the levator ani (deep PF muscle layers)?
- Pubococcygeus
- Iliococcygeus
- Ischiococcygeus
Which muscle is most important for voluntary control of the urethral & anal sphincter?
Pubococcygeus, 3 bands of fibres:
- Pubovaginalis
- Puborectalis
- Pubococcygeus proper
What is the function of the levator ani?
- 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
What are the 2 different types of PF muscles & their functions?
- Slow twitch: Constantly contracting during mobilisation to hold pelvic organs in position
- Fast twitch: Sustain short, sharp contractions
How is the lower urinary tract innervated?
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)
How does sympathetic control effect the bladder?
- Allows the bladder to fill
- Release of NE relaxes smooth muscles in bladder wall & excites smooth muscles in sphincter valve
How does parasympathetic control effect the bladder?
- 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
What are the normal voiding mechanisms?
- Brain sends nerve signals telling muscles to hold/expel urine
- Nerves send signals to the brain indicating when bladder is full or empty
What are the reversible causes of incontinence (DIAPPERS)?
- 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
What are the surgical causes of incontinence?
- Pelvic surgery
- Pelvic irradiation
- TURP/prostatectomy
- THR / # NOF
- Hernia repair
- Abdominal surgery
What are the medical causes of incontinence?
- Diabetes
- Neuro conditions (stroke, SCI etc.)
- Medications
- Chronic bowel disease
- Chronic cough
- Dementia
What are the biomechanics & environmental causes of incontinence?
- Increasing age
- Obesity
- COPD, smoker, hayfever
- Acute/chronic LBP/SIJ pain
- History of falls
- Reduced mobility, dexterity, eyesight, cognition
- Generalized weakness/debility
What are the exacerbating factors of incontinence?
- Diet: Low fibre, low fluid intake, caffeine
- Lifestyle: Obesity, smoking
- Physical environment: Lighting, distance (trip factor)
What age related changes can affect incontinence?
- Nervous system
- Bladder
- Urethra
- Co-morbidities (PD, dementia, COPD etc.)
What are the types of incontinence?
- Stress incontinence
- Urge incontinence
- Over-active bladder syndrome
- Overflow incontinence
- Nocturia/nocturnal enuresis
- Functional incontinence
- Faecal incontinence
What is stress incontinence & the implications for physio?
- 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
What is urge incontinence & the implications for physio?
- 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
What is overactive bladder syndrome (OAB) & the implications for physio?
- 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
What is overflow incontinence & the implications for physio?
- 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
What is nocturia?
- 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
What is nocturnal enuresis?
- 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
What is functional incontinence?
- Associated with inability to toilet because of cognitive/physical impairment or environmental barriers
What are other lower urinary tract symptoms?
- Frequency
- Voiding difficulties (poor/slow stream, dribble)
- Haematuria
- Dysuria
