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Specialties > Elderly- Incontinence > Flashcards

Elderly- Incontinence Flashcards

1
Q

Who is incontinence more common in?

A

Elderly

Women

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2
Q

What are the extrinsic causes of incontinence? (environment)

A
  • Physical state and co-morbidities
  • Reduced mobility
  • Confusion (delirium or dementia)
  • Drinking too much or at the wrong time
  • Medications, e.g. diuretics
  • Constipation
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3
Q

What are the intrinsic causes of incontinence?

A

Function of the bladder:
Urine storage:
Voluntary voiding:

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4
Q

What are the causes of incontinence due to the function of the bladder?

A

Urine storage

Voluntary void

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5
Q

What are the causes of incontinence due to urine storage?

A

Detrusor muscle relaxation

Volume of 400-600ml

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6
Q

What are the causes of incontinence due to Voluntary voiding?

A

Voluntary relaxation of external sphincter

Involuntary relaxation of internal sphincter and contraction of bladder

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7
Q

What are the different types of incontinence?

A

Urge incontinence
Stress incontinence
overflow incontinence

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8
Q

What is the cause of urge incontinence?

A

Overactivity of the detrusor muscle of the bladder

Bladder muscles are too strong

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9
Q

What are the characteristic features of urge incontinence?

A
  • Sudden urge to pass urine immediately

* Can be caused by bladder stones or stroke

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10
Q

What is the medical management of urge incontinence?

A

Anti-muscarinic (relax detrusor) e.g. oxybutinin, tolterodine, solifenacin

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11
Q

What is the non-pharmacological management of urge incontinence?

A

Bladder re-training

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12
Q

What causes stress incontinence?

A

Weakness of the pelvic floor muscle and sphincter muscles

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13
Q

What happens in stress incontinence?

A

Urine leaks when there is increased pressure on the bladder

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14
Q

What are the characteristic features of stress incontinence?

A

Sudden urge to pass urine, not arriving before urination occurs.

Urine leak on movement, coughing, laughing, squatting, etc.

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15
Q

Who is stress incontinence common in?

A

Women with children

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16
Q

What is the medical management of stress incontinence?

A

Oestrogen cream

Duloxetine

17
Q

What is the non-pharmacological management of stress incontinence?

A

Physiotherapy

18
Q

What are the surgical options of stress incontinence?

A

TVT/colposuspension

19
Q

What causes overflow incontinence?

A

Chronic urinary retention due to an obstruction to the outflow of urine.

20
Q

How does overflow incontinence present?

A

Without the urge to pass urine

21
Q

What are the characteristic features of overflow incontinence?

A
  • Poor urine flow, double voiding,
  • hesitancy, post micturition dribbling
  • Blockage to urethra
  • Older men with BPH
22
Q

What are the common causes of overflow incontinence?

A
  • Anticholinergic medications
  • Fibroids
  • Pelvic tumours
  • Neurological conditions- multiple sclerosis, diabetic neuropathy and spinal cord injuries
23
Q

What is the medical management of overflow incontinence?

A
  • Treat with alpha blocker- relaxes sphincter, e.g. tamsulosin
  • Treat with Anti-androgen- shrinks prostate, e.g. finasteride
24
Q

What surgery could you do for overflow incontinence?

A

TURP

25
Q

What may you also need to do if someone has overflow incontinence?

A

Suprapubic catheter

26
Q

What are some modifiable lifestyle factor for incontinence?

A
  • Caffeine
  • Alcohol
  • Medications
  • Body mass index (BMI)
27
Q

How would you assess the severity of the incontinence?

A
  • Frequency of urination
  • Frequency of incontinence
  • Nighttime urination
  • Use of pads and changes of clothing
28
Q

What investigations would you do on someone with incontinence?

A

A bladder diary kept for 3 days.
Urine dipstick- infection, and other pathology.
Post-void residual bladder volume- to assess for incomplete emptying.
Urodynamic testing

29
Q

When would you refer a patient to a specialist?

A 
Failure of initial management 
•	3 months of pelvic floor exercises
•	Cone therapy 
•	Bladder retraining 
•	Medication

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