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Physio in Specific Groups > Continence (Part 2) > Flashcards

Continence (Part 2) Flashcards

1
Q

What does assessment of continence include?

A
  • Clinical history (nature of problem, duration/severity of symptoms)
  • Medical and surgical history
  • Exacerbating factors
  • Functional and mental status
  • Impact of symptoms on QOL
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2
Q

Which HPs are in the management team for incontinence?

A
  • G.P.
  • Geriatrician, Urologist, Urogynaecologist
  • Continence nurse
  • Physiotherapist
  • Occupational therapist
  • Social worker
  • Dietician
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3
Q

What are the barriers to seeking help for incontinence?

A
  • Embarrassment
  • Social stigma
  • Inevitable, untreatable, normal part of ageing
  • Language, level of education and cultural factors
  • Lack of bathroom privacy
  • Inadequate identification & assessment by HPs
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4
Q

What are general management options for incontinence?

A
  • Empathy (supportive role of staff)
  • Improving environment (appropriate chair, rails in toilets, adequate lighting)
  • Promotion of good bladder habits
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5
Q

What are the 4 steps of good bladder habits?

A
  • Fluid intake
  • Good bowel habits
  • PF muscle exercises
  • Good toilet habits
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6
Q

What are the guidelines for fluid intake?

A
  • 1.5-2L per day
  • Limit caffeine & alcohol
  • Output 1-1.5L per day
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7
Q

What are good bowel habits?

A
  • Avoid constipation
  • Don’t ‘strain at stool’
  • Positions for defecation
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8
Q

How can PF exercises be made functional?

A
  • Ok to teach in lying but most don’t leak when in bed
  • Task orientated & functional
  • Specific to patient’s problem
  • Involved in ADLs
  • May need triggers as reminders
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9
Q

What are good toilet habits?

A
  • No “just in case” toileting

- Taking time to completely empty bladder

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10
Q

Why should “just in case” toileting be avoided?

A

Increased frequency&raquo_space; reduced stretching of bladder&raquo_space; decreased capacity&raquo_space; increased frequency

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11
Q

What are the aims of bladder training?

A
  • Decrease frequency
  • Increase urine quantity
  • Defer urge
  • Improve lifestyle
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12
Q

What does bladder training include?

A
  • Practise PFM exercises
  • Defer the urge
  • Start at home
  • Keep a bladder diary
  • Seek help re medication
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13
Q

What should be avoided during bladder training?

A
  • Decrease fluid intake
  • Just in case toilet
  • Wear pads
  • Drink caffeine and alcohol
  • Get stressed
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14
Q

What are the deferment strategies?

A
  • Contract PF muscles
  • Apply pressure to perineum (hold on, drop hip, corner of chair, roll towel, crossed thighs)
  • Distract mind/relax
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15
Q

How should deferment strategies be implemented?

A
  • Initially defer for 5 mins
  • Gradually increase time
  • Do not empty without urge
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16
Q

What are the physio interventions for incontinence?

A
  • PF muscle exercises
  • LL strength training
  • Upper limb function (buttons, zips)
  • Appropriate aids
17
Q

What are the continence strategies for RAC?

A
  • Mobility
  • Prompted voiding
  • Regular toileting
  • Use of continence service
18
Q

What is the aim of pharmacology in managing incontinence?

A
  • Increase bladder emptying & storage

- Increase/decrease outlet resistance

19
Q

What is anal incontinence?

A 
Involuntary loss of flatus, (liquid or solid) stool that is a social or hygienic problem
Can occur as a result of: 
- constipation
- neurological damage
- loss of sphincter control or 
- laxative abuse
20
Q

What are the risk factors for constipation?

A
  • Polypharmacy
  • Anticholinergic drugs
  • Opiates
  • Iron supplements
  • Calcium channel antagonists
  • NSAIDs
  • Immobility
  • Institutionalisation
  • PD
  • Diabetes mellitus
  • Low fluid intake
  • Low dietary fibre
  • Dementia
  • Depression
21
Q

What co-morbidities are related to faecal incontinence?

A
  • Dementia
  • CVA
  • Diabetes mellitus with neuropathy
  • Sacral cord dysfunction
22
Q

What are the causes of FI?

A
  • Functional FI
  • Anorectal incontinence: IAS, EAS dysfunction, prolapse
  • Loose stools / diarrhoea
  • Excessive laxative use
  • Rectal/colonic disease
23
Q

What are the causes of diarrhoea?

A
  • Stimulant laxatives
  • Bowel/stomach infection
  • Bowel disease
  • Drug interactions
  • Shortened bowel
  • Food intolerance
  • Radiotherapy
  • Alcohol
24
Q

What does diarrhoea management include?

A
  • GP/specialist review may be necessary
  • ?avoid insoluble fibres
  • ?increase intake of soluble fibres
  • ?increase fluid intake
  • ?drug therapy
  • Reduce alcohol, caffeine & smoking
25
Q

What does management of constipation include?

A
  • Firstly relieve the constipation, then revise the management
  • Dietary: Fibre intake
  • Fluids: 1.5-2 L non-irritative drinks
  • Laxatives/Aperients
  • Activity/Exercise
  • Aids and appliances
  • Environment (accessibility of toilet)
26
Q

What are the signs & symptoms of urinary tract infections?

A

Signs:

  • Increased body temperature
  • +ve urine microbial culture with large number of pus cells
  • Voiding dysfunction

Symptoms:

  • Confusion, febrile, smelly urine
  • Frequency/urgency
  • Stinging
27
Q

What is the treatment for UTI?

A
  • Antibiotics
  • Decrease pelvic floor & anterior urethral colonisation
  • Personal hygiene (washing perineum, underwear etc)
28
Q

What are the principles of catheter use?

A
  • Relieve and manage urinary dysfunction
  • Recognise & minimize risks of secondary complications
  • Promote dignity and comfort
  • Assist clients to reach self care & independence
29
Q

What are the types of catheters?

A
  • Suprapubic catheter (SPC)
  • Indwelling catheter (IDC)
  • Intermittent self catheterization (CISC or ISC)
30
Q

What are the precautions for catheter use?

A
  • Ensure urine is always allowed to flow freely
  • No kinks in the tubing
  • Urine bag must be kept below the level of the bladder
  • Catheter secured with a leg strap to prevent being pulled out
31
Q

What is the function of the PF?

A
  • Pelvic organ support
  • Additional occlusive force to external urethral sphincter
  • Maintain anorectal angle
  • Rectal support during defecation
  • Bladder inhibition
  • Sexual function
32
Q

What factors contribute to PF dysfunction?

A
  • Type of connective tissue
  • Pregnancy, labour, delivery
  • Menopause, ageing
  • Medication
  • Lifestyle
  • Stretching of support structures
  • Perineal trauma
  • Urinary retention
  • Postnatal care of perineum
33
Q

What is pelvic organ prolapse (POP)?

A

Descent of pelvic organs towards the introitus

associated with vaginal wall & pelvic ligament weakness

34
Q

What are the causes of POP?

A
  • Stretched pelvic fascia & ligaments following very fast or very long 2nd stages
  • Many large babies
  • Patients with “cervix on view” at delivery are at higher risk of future prolapse
  • Constipation and chronic cough
  • Heavy lifting
  • Chronic LBP with weak TA
35
Q

What is the treatment for prolapse?

A
  • Strengthen lower abs & PF
  • Address constipation and respiratory disease
  • Modify lifestyle

These measures will not cure vaginal wall
prolapse but may prevent further descent and will give surgery a better long-term outcome

36
Q

What is chronic pelvic pain?

A
  • Chronic or recurrent pelvic pain that apparently has a gynaecological origin but for which no definitive or cause is found
  • Perceived in structures related to the pelvis
  • Pain associated with symptoms of LUT, sexual, bowel or gynaecological dysfunction
37
Q

What should the assessment of PFM include?

A
  • Visual inspection
  • Observation
  • Sensation and neural
  • Palpation external/internal
  • PFM contractile activity
  • Spasm
  • Relaxation
38
Q

What is the pain behaviour chronic pelvic pain?

A
  • May have mechanical component
  • Aggravated by stress
  • Not necessarily associated with spinal dysfunction
  • If spinal dysfunction present, may interact with myofascial dysfunction
  • Visceral symptoms may be present (diarrhoea, constipation, period pain)
39
Q

What are the treatments for chronic pelvic pain & PF dysfunction?

A
  • Lifestyle interventions
  • Exercises
  • Down training
  • Manual therapy (Myofacial and trigger points)
  • Biofeedback and electrical stims
  • Dilators

Physio in Specific Groups (12 decks)

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