Elderly incontinence Flashcards
What type of muscle are the urethral sphincters?
Internal= smooth EXternal= striated
What are the functions of the bladder>
Urine storage
Voluntary voiding
What is the normal volume if the bladder?
400-600ml
What is the parasympathetic innervation of the bladder?
S2-4
What is the function of the parasympathetic innervation of the bladder?
Inceases strength and frequency of contractions
What is the sympathetic innervation of the bladder?
T10-S2
What is the function of the B adrenoceptors of bladder?
Causes detrusor to relax
What is the function of the a adrenoceptors of bladder?
Causes contraction of neck of bladder and internal urethral sphincter
What is the somatic innervation of the bladder?
S2-4
What is th function of somatic innervation of the urinary system?
Contracts pelvic floor and external urethral sphincter
What are the causes of incontinence extrinsic to urinary system?
Physical state and co-morbidity Reduced mobility Confusion Diuretics Constipation Home circumstance Social circumstance
What causes stress incontinence?
Weakness of pelvic floor
What is stress incontinence?
Incontinence on movement or with raised intra abdominal pressure
What are the treatments for stress incontinence?
Physio- pelvic floor exercises Vaginal coes Oestrogen cream Duloxetine Biofeedback/pelvic floor stimulators Surgery- TVT, colposuspension
What causes urinary retention with overflow incontinence?
Blockage to urethra, commonly BPH
What are the characteristic features of urinary retention wth overflow incontinence?
Poor urine flow
Terminal dribbling
Hesitancy
Double voiding
What is the treatment of urinary retention with overflow incontinence?
Alpha blocker
Anti androgen
Surgery
Catheterisation
What is the function of an alpha blocker in urinary retention with overflow incontinence?
Relaxes sphincter
What is the function of an anti androgen in urinary retention with overflow incontinence?
Shrink prostate
What ar some alpha blockers used in urinary retention with overflow incontinence?
Tamsulosin
Terazosin
What are some anti androgens used for BPH?
Finasteride
What causes urge incontinence>
Nerve issues
Overactive bladder
Bad bladder habits
Wha are the characteristic features of urge incontinence?
Sudden urge to pass urine immediately, often with leakage
What is the treatment of urge incontinence?
Anti muscarinics e.g. oxybutinin
Bladder re training
What is a neuropathic bladder?
Underactive bladder
What causes an underactive bladder?
Neuro disease e.g. stroke, MS
Prolonged catheterisation
What is the treatment of an underactive bladder?
Catheter
Parasympathomimetics may help
What are the indications for a referral to specialist with urinary incontinence?
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
What are the indications for referral with faecal incontinence?
Failure of initial management
At onset if
-suspected sphincter damage
-neuro disease
What are th management options if all else fails?
Incontinence pads Urosheaths Intermittent catheterisation Long term catheter Suprapubic catheter
