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Geriatrics > Elderly Continence > Flashcards

Elderly Continence Flashcards

1
Q

State the prevalence of incontinence in women

A

34%

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2
Q

State the prevalence of incontinence in older adults

A

30-50%

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3
Q

Incontinence is seen to be a big contributor to

A

Functional decline

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4
Q

Define Urinary Incontinence

A

Unintentional passing of urine

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5
Q

State what bladder control is dependant on

A 
Functioning bladder
Functioning sphincters
Cognition
Mobility
Dexterity
Environment
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6
Q

What happens to the bladder in age

A

Reduced capacity, reduced residual volume, prostate hypertrophy, increased urine production at night, vaginal atrophy

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7
Q

State the co-morbidities that can contribute to incontinence

A

Decreased mobility, bladder outlet obstruction, constipation, stroke, spinal chord pathology, cognitive impairment

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8
Q

State the reversible factors that can result in incontinence

A

UTI, prolapse, delirium, medications, polydypsia

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9
Q

State the environmental factors that can contribute to incontinence

A

Toilet on a different level, mobility, assistance

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10
Q

Control of detrusor muscle

A

Involuntary control

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11
Q

Control of internal urethral sphincter

A

Involuntary which usually opens when bladder is half full

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12
Q

Control of external urethral sphincter

A

Striated muscle therefore voluntary

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13
Q

Parasympathetic innervation of the bladder

A

S2-S4 (Muscarinic receptors) leads to detrusor muscle contractions and promotes urination

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14
Q

Sympathetic innervation of the bladder

A

T10-L2 (B2 adrenoreceptors) detrusor muscle relaxation

T10-S2 (a adrenoreceptors) internal sphincter contraction

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15
Q

Motor innervation of urination

A

S2-S4 external sphincter contraction

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16
Q

Describe the process of urinartion (reflex)

A

Stretch receptors stimulated, spinal chord, parasympathetic nerves stimulated and therefore detrusor muscle contraction

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17
Q

Pontine micturition control centre

A

Blocks the parasympathetic actions and leads to detrusor relaxation so allows the storage of urine

18
Q

Frontal cortex control of urine

A

Voluntary voiding of urine

19
Q

What is stress incontinence

A

Urine typically leaks with increased abdominal pressures - coughing, sneezing, laughing, standing up

20
Q

Why does stress incontinence occur

A

Outlet from the bladder is weak - weak external sphincter and weak pelvic floor muscles

21
Q

When is stress incontinence common

A

In women who have had children, more so after menopause

22
Q

What is urge incontinence

A

Associated with the sudden urge to pass urine

23
Q

What is the cause of urge incontinence

A

Detrusor muscle instability (overactive bladder) and contracts with low urine volumes. Due to UMN lesion or detrusor muscle disorder.

24
Q

State the common presentation of urge incontinence

A

Frequency and nocturnal incontinence

25
Q

What is overflow incontinence

A

Urine is retained in the bladder with subsequent overflow

26
Q

What causes overflow incontinence

A

Bladder outlet obstruction (prostatic hypertrophy or tumour) and constipation

27
Q

State the typical symptoms with overflow incontinence

A

Hesitancy, reduced stream and post-micturition dribbling

28
Q

State what the patient can do to help identify what type of incontinence they may have

A

Patient diary over 3 days

29
Q

State the examinations that can be performed on the patient

A

Determine strength of the pelvic floor muscles, assess for constipation, assess for prolapse

30
Q

State the investigations that can be conducted in incontinence

A

Urinalysis/MSSU, bladder scan (check residual volume), urodynamics (cystometry, uroflowmetry)

31
Q

State general measures used in the management of incontinence

A

Weight control, fluid control, reduce bladder irritants (caffeine, fruit juice and alcohol), pelvic floor exercises, bladder retraining, pads/urinals

32
Q

State the first line treatment of stress incontinence

A

Pelvic floor exercises (kegel exercises)

33
Q

State minimum amount of contractions done a day (minimum)

A

8 contractions 3 times a day

34
Q

How long will pelvic floor exercises take to have an effect

A

3 months

35
Q

State aids available for the pelvic floor exercises

A

Biofeedback (measuring how the muscles are working), vaginal cones, electrical stimulation (when cannot actively contract pelvic floor muscles)

36
Q

State the surgical treatments for stress incontinence

A

Colposuspension, TVT tape

37
Q

State the first line treatment of urge incontinence

A

Bladder retraining and pelvic floor exercises

38
Q

State the medications which are used in urge incontinence

A

Anti-cholinergics (to relax the detrusor muscle). Oxybutynin, tolterodine and solifenacin.

39
Q

State the side effects of anti-cholinergics

A

Cognitive impairment, dry mouth, constipation, blurred vision, postural hypotension, drowsiness, urinary retention

40
Q

State the other treatments for urge incontinence

A

Botulinum toxin (to relax detrusor muscle) and sacral nerve stimulation

41
Q

State the management of overflow incontinence

A

Relieve the obstruction - prostatic hypertrophy/tumour (anti-androgen, finasteride)

Relax the sphincter - prostatic hypertrophy (alpha blocker)

By-pass the obstruction - catheter

42
Q

State the criteria for the use of catheters

A

Symptomatic urinary retention, bladder outflow tract obstruction, undue stress caused by alternative management

Geriatrics (8 decks)

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