Elderly Continence Flashcards
State the prevalence of incontinence in women
34%
State the prevalence of incontinence in older adults
30-50%
Incontinence is seen to be a big contributor to
Functional decline
Define Urinary Incontinence
Unintentional passing of urine
State what bladder control is dependant on
Functioning bladder Functioning sphincters Cognition Mobility Dexterity Environment
What happens to the bladder in age
Reduced capacity, reduced residual volume, prostate hypertrophy, increased urine production at night, vaginal atrophy
State the co-morbidities that can contribute to incontinence
Decreased mobility, bladder outlet obstruction, constipation, stroke, spinal chord pathology, cognitive impairment
State the reversible factors that can result in incontinence
UTI, prolapse, delirium, medications, polydypsia
State the environmental factors that can contribute to incontinence
Toilet on a different level, mobility, assistance
Control of detrusor muscle
Involuntary control
Control of internal urethral sphincter
Involuntary which usually opens when bladder is half full
Control of external urethral sphincter
Striated muscle therefore voluntary
Parasympathetic innervation of the bladder
S2-S4 (Muscarinic receptors) leads to detrusor muscle contractions and promotes urination
Sympathetic innervation of the bladder
T10-L2 (B2 adrenoreceptors) detrusor muscle relaxation
T10-S2 (a adrenoreceptors) internal sphincter contraction
Motor innervation of urination
S2-S4 external sphincter contraction
Describe the process of urinartion (reflex)
Stretch receptors stimulated, spinal chord, parasympathetic nerves stimulated and therefore detrusor muscle contraction
Pontine micturition control centre
Blocks the parasympathetic actions and leads to detrusor relaxation so allows the storage of urine
Frontal cortex control of urine
Voluntary voiding of urine
What is stress incontinence
Urine typically leaks with increased abdominal pressures - coughing, sneezing, laughing, standing up
Why does stress incontinence occur
Outlet from the bladder is weak - weak external sphincter and weak pelvic floor muscles
When is stress incontinence common
In women who have had children, more so after menopause
What is urge incontinence
Associated with the sudden urge to pass urine
What is the cause of urge incontinence
Detrusor muscle instability (overactive bladder) and contracts with low urine volumes. Due to UMN lesion or detrusor muscle disorder.
State the common presentation of urge incontinence
Frequency and nocturnal incontinence
What is overflow incontinence
Urine is retained in the bladder with subsequent overflow
What causes overflow incontinence
Bladder outlet obstruction (prostatic hypertrophy or tumour) and constipation
State the typical symptoms with overflow incontinence
Hesitancy, reduced stream and post-micturition dribbling
State what the patient can do to help identify what type of incontinence they may have
Patient diary over 3 days
State the examinations that can be performed on the patient
Determine strength of the pelvic floor muscles, assess for constipation, assess for prolapse
State the investigations that can be conducted in incontinence
Urinalysis/MSSU, bladder scan (check residual volume), urodynamics (cystometry, uroflowmetry)
State general measures used in the management of incontinence
Weight control, fluid control, reduce bladder irritants (caffeine, fruit juice and alcohol), pelvic floor exercises, bladder retraining, pads/urinals
State the first line treatment of stress incontinence
Pelvic floor exercises (kegel exercises)
State minimum amount of contractions done a day (minimum)
8 contractions 3 times a day
How long will pelvic floor exercises take to have an effect
3 months
State aids available for the pelvic floor exercises
Biofeedback (measuring how the muscles are working), vaginal cones, electrical stimulation (when cannot actively contract pelvic floor muscles)
State the surgical treatments for stress incontinence
Colposuspension, TVT tape
State the first line treatment of urge incontinence
Bladder retraining and pelvic floor exercises
State the medications which are used in urge incontinence
Anti-cholinergics (to relax the detrusor muscle). Oxybutynin, tolterodine and solifenacin.
State the side effects of anti-cholinergics
Cognitive impairment, dry mouth, constipation, blurred vision, postural hypotension, drowsiness, urinary retention
State the other treatments for urge incontinence
Botulinum toxin (to relax detrusor muscle) and sacral nerve stimulation
State the management of overflow incontinence
Relieve the obstruction - prostatic hypertrophy/tumour (anti-androgen, finasteride)
Relax the sphincter - prostatic hypertrophy (alpha blocker)
By-pass the obstruction - catheter
State the criteria for the use of catheters
Symptomatic urinary retention, bladder outflow tract obstruction, undue stress caused by alternative management
