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Clinical Specialities > Elderly Incontinence > Flashcards

Elderly Incontinence Flashcards

1
Q

true or false

incontinence is 3 times higher in men

A

false it is higher in women

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2
Q

what are some extrinsic causes of incontinence?

A 
> co-morbidities
> reduced mobility
> confusion
> drinking too much or at he wrong time
> diuretics
> constipation
> home circumstances
> social circumstances
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3
Q

what does continence depend on?

A

> effective function of the bladder

> integrity of the neural connections bringing it under voluntary control

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4
Q

what is the function of the bladder?

A

> urine storage

> volume voiding

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5
Q

what is the effect of S2-S4 parasympathetic nerves?

A

> increasing strength of contractions

> increasing frequency of contractions

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6
Q

what is the effect of sympathetic nerves on beta adrenoreceptors on the detrusor muscle?

A

relaxation

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7
Q

what is the effect of sympathetic nerves on alpha adrenoreceptors on the detrusor muscle?

A

contraction on the neck of the bladder and the internal urethral sphincter

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8
Q

what effect do somatic nerves form S2-S4 have on the pelvic floor and external urethral sphincter?

A

contraction

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9
Q

how do centres within the CNS allow for urine storage?

A

> inhibit parasympathetic tone

> promote bladder relaxation

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10
Q

what causes stress incontinence?

A

weakness of the bladder outlet

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11
Q

what are the characteristic features of stress incontinence?

A

> urine leak on movement (cough, laugh, squat)
weak pelvic floor muscles
common in women with children after menopause

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12
Q

what treatment is there for stress incontinence?

A

physiotherapy
> pelvic floor exercises
> vaginal cone

oestrogen cream
> if vulva Is red and atrophies

duloxetine
> antidepressant

surgical option
> TVT/colposuspension

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13
Q

what is the pathophysiology of urinary retention with overflow incontinence?

A

the bladder outlet is too strong.

caused by a blockage in the urethra

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14
Q

what can cause urinary retention with overflow incontinence?

A

> BPH

> women who have survived cervical cancer

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15
Q

what are the characteristic features of urinary retention with overflow incontinence?

A

> poor urine flow
double voiding
hesitancy
post micturition bleeding

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16
Q

what treatment is there for urinary retention with overflow incontinence?

A

> alpha blocker (relaxes sphincter) [Tamsulosin]
antiandrogen (shrinks prostate) [finasteride]
surgery (transurethral resection of prostate)
catheterisation

17
Q

what causes urge incontinence?

A

> bladder muscle too strong
bladder stones
stroke

18
Q

what are the characteristic features of urge incontinence?

A

> detrusor muscle contracts at low volumes
sudden urge to pass urine immediately
women usually affected

19
Q

hoe is urge incontinence treated?

A

> antimuscarinics [oxybutynin]

> bladder retraining (going to toilet every 1.5 hours)

20
Q

name an antimuscarinic

A

> oxybutynin
tolterodine
solifenacin
trospium

21
Q

name a beta-3 adrenoceptor agonist

A

> mirabegron

22
Q

name an alphaablocker

A

> Tamsulosin
terazosin
indoramin

23
Q

name an antiandrogen drug

A

> finasteride

> dutasteride

24
Q

what is a neuropathic bladder?

A

an under-reactive bladder

25
Q

what is a neuropathic bladder caused by?

A

> prolonged catherization

> neurological disease

26
Q

what are the characteristic features of a neuropathic bladder?

A

no awareness of bladder filling resulting in overflow incontinence

27
Q

what si the treatment for a neuropathic bladder?

A

catheterisation

28
Q

how would you assess urine incontinence?

A 
> history
> intake chart and urine output diaries
> general examination and rectal and vaginal examinations
> urinalysis and MSSU
> bladder scan for residual volume
> referral to incontinence clinical?
> look at drugs
29
Q

when should you refer to a specialist clinic?

A 
> after failure or initial management
> vesico-vaginal fistula
> palpable bladder after micturition
> confirmed large residual volume of urine after micturition
> disease of the CNS
> severe BPH or carcinoma
> previous surgery for continence problems
> diagnosis has not been made
30
Q

when would you refer faecal incontinence patients?

A

> failure of initial management with constipation or diarrhoea with normal sphincter
suspected sphincter damage
neurological disease

31
Q

if all other management fails what other options are there?

A 
> incontinence pads
> urosheaths
> intermittent catheterisation
> long term urinary catheter
> suprapubic catheter

Clinical Specialities (6 decks)

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