Elderly- Incontinence Flashcards
Who is incontinence more common in?
Elderly
Women
What are the extrinsic causes of incontinence? (environment)
- Physical state and co-morbidities
- Reduced mobility
- Confusion (delirium or dementia)
- Drinking too much or at the wrong time
- Medications, e.g. diuretics
- Constipation
What are the intrinsic causes of incontinence?
Function of the bladder:
Urine storage:
Voluntary voiding:
What are the causes of incontinence due to the function of the bladder?
Urine storage
Voluntary void
What are the causes of incontinence due to urine storage?
Detrusor muscle relaxation
Volume of 400-600ml
What are the causes of incontinence due to Voluntary voiding?
Voluntary relaxation of external sphincter
Involuntary relaxation of internal sphincter and contraction of bladder
What are the different types of incontinence?
Urge incontinence
Stress incontinence
overflow incontinence
What is the cause of urge incontinence?
Overactivity of the detrusor muscle of the bladder
Bladder muscles are too strong
What are the characteristic features of urge incontinence?
- Sudden urge to pass urine immediately
* Can be caused by bladder stones or stroke
What is the medical management of urge incontinence?
Anti-muscarinic (relax detrusor) e.g. oxybutinin, tolterodine, solifenacin
What is the non-pharmacological management of urge incontinence?
Bladder re-training
What causes stress incontinence?
Weakness of the pelvic floor muscle and sphincter muscles
What happens in stress incontinence?
Urine leaks when there is increased pressure on the bladder
What are the characteristic features of stress incontinence?
Sudden urge to pass urine, not arriving before urination occurs.
Urine leak on movement, coughing, laughing, squatting, etc.
Who is stress incontinence common in?
Women with children
What is the medical management of stress incontinence?
Oestrogen cream
Duloxetine
What is the non-pharmacological management of stress incontinence?
Physiotherapy
What are the surgical options of stress incontinence?
TVT/colposuspension
What causes overflow incontinence?
Chronic urinary retention due to an obstruction to the outflow of urine.
How does overflow incontinence present?
Without the urge to pass urine
What are the characteristic features of overflow incontinence?
- Poor urine flow, double voiding,
- hesitancy, post micturition dribbling
- Blockage to urethra
- Older men with BPH
What are the common causes of overflow incontinence?
- Anticholinergic medications
- Fibroids
- Pelvic tumours
- Neurological conditions- multiple sclerosis, diabetic neuropathy and spinal cord injuries
What is the medical management of overflow incontinence?
- Treat with alpha blocker- relaxes sphincter, e.g. tamsulosin
- Treat with Anti-androgen- shrinks prostate, e.g. finasteride
What surgery could you do for overflow incontinence?
TURP
What may you also need to do if someone has overflow incontinence?
Suprapubic catheter
What are some modifiable lifestyle factor for incontinence?
- Caffeine
- Alcohol
- Medications
- Body mass index (BMI)
How would you assess the severity of the incontinence?
- Frequency of urination
- Frequency of incontinence
- Nighttime urination
- Use of pads and changes of clothing
What investigations would you do on someone with incontinence?
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
When would you refer a patient to a specialist?
Failure of initial management • 3 months of pelvic floor exercises • Cone therapy • Bladder retraining • Medication
