Elderly incontinence

Question 1

What type of muscle are the urethral sphincters?

Answer 1

Internal= smooth
EXternal= striated

Question 2

What are the functions of the bladder>

Answer 2

Urine storage

Voluntary voiding

Question 3

What is the normal volume if the bladder?

Answer 3

400-600ml

Question 4

What is the parasympathetic innervation of the bladder?

Answer 4

S2-4

Question 5

What is the function of the parasympathetic innervation of the bladder?

Answer 5

Inceases strength and frequency of contractions

Question 6

What is the sympathetic innervation of the bladder?

Answer 6

T10-S2

Question 7

What is the function of the B adrenoceptors of bladder?

Answer 7

Causes detrusor to relax

Question 8

What is the function of the a adrenoceptors of bladder?

Answer 8

Causes contraction of neck of bladder and internal urethral sphincter

Question 9

What is the somatic innervation of the bladder?

Answer 9

S2-4

Question 10

What is th function of somatic innervation of the urinary system?

Answer 10

Contracts pelvic floor and external urethral sphincter

Question 11

What are the causes of incontinence extrinsic to urinary system?

Answer 11

Physical state and co-morbidity
Reduced mobility
Confusion
Diuretics
Constipation
Home circumstance
Social circumstance

Question 12

What causes stress incontinence?

Answer 12

Weakness of pelvic floor

Question 13

What is stress incontinence?

Answer 13

Incontinence on movement or with raised intra abdominal pressure

Question 14

What are the treatments for stress incontinence?

Answer 14

Physio- pelvic floor exercises
Vaginal coes
Oestrogen cream
Duloxetine
Biofeedback/pelvic floor stimulators
Surgery- TVT, colposuspension

Question 15

What causes urinary retention with overflow incontinence?

Answer 15

Blockage to urethra, commonly BPH

Question 16

What are the characteristic features of urinary retention wth overflow incontinence?

Answer 16

Poor urine flow
Terminal dribbling
Hesitancy
Double voiding

Question 17

What is the treatment of urinary retention with overflow incontinence?

Answer 17

Alpha blocker
Anti androgen
Surgery
Catheterisation

Question 18

What is the function of an alpha blocker in urinary retention with overflow incontinence?

Answer 18

Relaxes sphincter

Question 19

What is the function of an anti androgen in urinary retention with overflow incontinence?

Answer 19

Shrink prostate

Question 20

What ar some alpha blockers used in urinary retention with overflow incontinence?

Answer 20

Tamsulosin

Terazosin

Question 21

What are some anti androgens used for BPH?

Answer 21

Finasteride

Question 22

What causes urge incontinence>

Answer 22

Nerve issues
Overactive bladder
Bad bladder habits

Question 23

Wha are the characteristic features of urge incontinence?

Answer 23

Sudden urge to pass urine immediately, often with leakage

Question 24

What is the treatment of urge incontinence?

Answer 24

Anti muscarinics e.g. oxybutinin

Bladder re training

Question 25

What is a neuropathic bladder?

Answer 25

Underactive bladder

Question 26

What causes an underactive bladder?

Answer 26

Neuro disease e.g. stroke, MS

Prolonged catheterisation

Question 27

What is the treatment of an underactive bladder?

Answer 27

Catheter

Parasympathomimetics may help

Question 28

What are the indications for a referral to specialist with urinary incontinence?

Answer 28

Referral after failure of initial management for 3 months
At onset if
-vesico vaginal fistula
-palpable bladder post micturition/confirmed large residual urine volume
-CNS disease
-certain gyn conditions
-severe BPH or prostatic carcinoma
-previpus incontinence surgery

Question 29

What are the indications for referral with faecal incontinence?

Answer 29

Failure of initial management
At onset if
-suspected sphincter damage
-neuro disease

Question 30

What are th management options if all else fails?

Answer 30

Incontinence pads
Urosheaths
Intermittent catheterisation
Long term catheter
Suprapubic catheter