Elderly - continence Flashcards
what is the prevalence of urinary incontinence in different living situations
residential care - 25%
nursing home care - 40%
hospital care - 50-70%
is urinary incontinence more common in men or women
3x more common in women
what is incontinence
a symptom with many causes - uncontrolled leakage of urine
what are the two groups of causes for incontinence
extrinsic - environmental, habit, physical fitness, etc
intrinsic - problem with bladder or urinary outlet
BUT often caused by a mix of both
list some extrinsic factors
Physical state and co-morbidities Reduced mobility Confusion (delirium or dementia) Drinking too much or at the wrong time Diuretics Constipation Home circumstances Social circumstances
what does continence depend on
effective function of the bladder
integrity of local innervation and CNS connections
what are the functions of the bladder
urine storage
voluntary voiding
how does urine storage work
involves the detrusor muscle relaxing and filling to normal volume, combined with sphincter contraction
how does voluntary voiding work
voluntary relaxation of external sphincter
involuntary relaxation of internal sphincter
contraction of bladder
what are the three components of local innervation
parasympathetic
sympathetic
somatic
what is the parasympathetic innervation of the bladder/urethra and what does it do
S2-S4 - increases strength and frequency of contractions
what is the sympathetic innervation of the bladder/urethra and what does it do
- T10-L2
- B-adrenorecepto: causes detrusor to relax - T10-S2
- a-adrenoreceptor: causes contraction of neck of bladder, and internal urethral sphincter
what is the somatic innervation of the bladder/urethra and what does it do
S2-S4 - contraction of pelvic floor muscle (urogenital diaphragm) and external urethral sphincter
what are the CNS components of urine storage
centres in the CNS inhibit parasympathetic tone - promote bladder relaxation = storage of urine
what are the CNS components of sphincter closure
sphincter closure mediated by reflex increase in a-adrenergic and somatic activity
what are the CNS components of voluntary voiding
pontine micturition centre normally exerts a “storage program” of neural connections until a voluntary switch to a “voiding program” occurs.
what is stress incontinence/how does it occur
leakage of urine due to the bladder outlet being too weak
what are characteristic features of stress incontinence
urine leak on movement, coughing, laughing, etc
weak pelvic floor muscles
common in women with children, esp after menopause
what are the treatment options for stress incontinence
physiotherapy
- pelvic floor/kegal exercises, vaginal cones, biofeedback, pelvic floor stimulators
oestrogen cream, duloxetine
surgical - TVT/colposuspension
what is overflow incontinence/how does it occur
urine leakage due to bladder outlet being too strong which leads to urinary retention
what are characteristic features of urinary retention with overflow incontinence
poor urine flow, double voiding, hesitance, post micturition dribble
blockage to urethra
usually in older men with BPH
what are the treatment options for urinary retention with overflow incontinence
alpha blockers (relaxes sphincter eg tamsulosin)
anti-androgens (shrinks prostate eg finasteride
surgery (TURP)
may need catheterisation, often suprapubic
what is urge incontinence/how does it occur
urine leakage due to bladder muscle being too strong
what are characteristic features of urge incontinence
detrusor contracts at low volumes of stored urine
leads to sudden urge to pass urine immediately
patients often know every public toilet
can be caused by bladder stones or stroke
