Elderly Continence Flashcards
Define urinary incontinence
Unintentional passing of urine
What is bladder control dependent on?
Functioning bladder Functioning sphincters Cognition Mobility Dexterity Environment
What are the different muscles associated with the bladder?
Detrusor muscle
Internal urethral sphincter
External urethral sphincter
How do the urethral sphincters differ from each other?
Internal is smooth muscle under involuntary action
External is striated muscle under voluntary action
What is the innervation of the bladder?
Parasympathetic (muscarinic receptors) S2-4
Sympathetic T10-L2 (b2 adrenoreceptors) and T10-S2 (alpha adrenoreceptors)
Motor S2-4
What is the purpose of the pontine micturition centre?
Blocks the parasympathetic actions leading to detrusor relaxation and storage of urine
What are the causes of stress incontinence?
Urine typically leaks with increased abdominal pressure (coughing, sneezing, laughing etc)
Weak external sphincter or pelvic floor muscles
Childbirth
What is urge incontinence?
Incontinence associated with the sudden urge to pass urine
What are the common symptoms of urge incontinence?
Frequency
Nocturnal incontinence
UMN lesion or detrusor muscle disorder
What is overflow incontinence?
Urine is retained in the bladder with subsequent overflow
What are the symptoms of overflow incontinence?
Hesitancy
Reduced stream
Post-micturition dribbling
What investigations can be used for incontinence?
History Bladder diary Examination (abdominal/PV/PR) Urinalysis/MSSU Bladder scan Urodynamics
What are the treatment options for incontinence?
Weight control Fluid control Reduce bladder irritants (caffeine, alcohol) Pelvic floor exercises Bladder retraining
What are the specific treatments for stress incontinence?
Pelvic floor exercises
Surgery (TVT tape, colposuspension)
What are the specific treatments for urge incontinence?
Bladder retraining programme Prompted, regular toileting Anti-cholinergics Beta-3-adrenoceptor agonists Botulinum toxin Sacral nerve stimulation
