Elderly - Continence Flashcards
How common is incontinence in patients in hospital care?
50-70%
How common is incontinence in patients in nursing home care?
40%
How common is incontinence in patients in residential care?
25%
Urinary incontinence is most common in which gender?
Women (3x as likely)
What are the causes of Urinary incontinence?
Extrinsic (environment, habit)
Intrinsic (body)
What are the extrinsic causes of Urinary incontinence?
Physical state Co-morbidities Reduced mobility Confusion Drinking too much Medications Constipation Home/social circumstances
What are the muscles of the bladder and urethra, and what is their control?
Detrusor - smooth muscle
Internal urethral sphincter - smooth muscle
External urethral sphincter - striated muscle
What is the local innervation of urinary continence?
S2-4 (Parasympthetic)
T10-L2 (Sympathetic)
T10-S2 (Sympathetic)
S2-S4 (Somatic)
What is the role of parasympathetic innervation of the urinary system?
Increased strength and frequency of contractions
What is the role of Sympathetic innervation of the urinary system?
Beta adrenoreceptor - detrusor relaxation
Alpha adrenoreceptor - Contraction of neck of bladder, internal urethral sphincter
What is the role of somatic innervation of the urinary system?
Contraction of pelvic floor and external urethral sphincter
What are the neurological controls of micturition?
Pontine micturition centre
Frontal cortex
Caudal spinal cord
What are the causes of stress incontinence?
Bladder outlet too weak
What are the features of stress incontinence?
Urine leak on movement/coughing/laughing
Weak pelvic floor
Common in women with children
What are the treatments for stress incontinence?
Physio (kegel exercises) Estrogen cream/pessaries Duloxatine Surgery (TVT/Colposuspension) Biofeedback Pelvic floor stabilisers
What are the characteristic features of overflow incontinence?
Poor flow Double voiding Post-micturition dribbling Blockage to urethra Older men - BPH
How is overflow incontinence treated?
Alpha blockers
Anti-androgens
Surgery - TURP
What are the characteristic features of urge incontinence?
Detrusor contracts at low volumes
Sudden urge to pass urine
Patients often know every public toilet
Associated with bladder stones or stroke
How is urge incontinence treated?
Anti-muscarinics
Bladder re-training
How to antimuscarinics work for incontinence?
Relax detrusor muscle
How do Beta-3 adrenoceptor agonists work for incontinence?
Relax detrusor muscle
How do alpha-blockers work for incontinence?
Relax sphincter and bladder neck
What is a neuropathic bladder?
Bladder that cannot contract, leading to atrophy of the detrusor muscle
What are the characteristic features of neuropathic bladder?
Secondary to neurological disease (MS, Stroke) or prolonged catheterisation
No awareness of full bladder
How is neuropathic bladder treated?
Parasympathomimetics (extensive side-effects)
Catheterisation
How should incontinence be assessed?
History with extensive social Hx Intake/Output chart General exam + rectal and vaginal Urinalysis and MSSU Residual bladder scan Incontinence clinic Consider Rx
What are the indications for referral to urinary incontinence specialists?
After failure of initial management max 3 months Fistula Large residual volume CNS disease BPH Previous continence surgery
When should faecal incontinence be referred?
Failure of initial diarrhoea/constipation management
Suspected sphincter damage
Neurological damage
What are the last options in incontinent patients?
Pads Urosheaths Intermittent catheterisation Long-term catheter Suprapubic catheter
