Elderly incontinence

Question 1

Is urinary incontinence more common in males or females?

Answer 1

Females

Question 2

What are causes of incontinence extrinsic to the urinary system?

Answer 2

Physical state and co-morbidities
Reduced mobility
Confusion - delirium
Drinking too much at wrong time
Medications - diuretics
Constipation
Home/social circumstances

Question 3

What are the 2 main causes of incontinence intrinsic to the urinary system?

Answer 3

Problem with bladder

Problem with urinary outlet

Question 4

What does continence depend on?

Answer 4

Function of bladder

Integrity of neural connections bringing it under voluntary control

Question 5

What is the normal innervation of the bladder?

Answer 5

S2-S4 parasympathetics
T10-L2 parasympathetic
S2-S4 somatic

Question 6

What problems with bladder and outlet lead to incontinence?

Answer 6

Too weak or too strong

Question 7

What is stress incontinence?

Answer 7

Bladder outlet is too weak

Question 8

What are characteristic features of stress incontinence?

Answer 8

Urine leak on movement, cough, laugh, squat, etc
Weak pelvic floor muscles
Common in women with children and menopause

Question 9

What are treatment options for stress incontinence?

Answer 9

Physiotherapy
Oestrogen cream
Duloxetine
Surgery

Question 10

What is physiotherapy for stress incontinence?

Answer 10

Kegel exercises

Question 11

What is urinary retention with overflow incontinence?

Answer 11

Bladder outlet too strong

Question 12

What are characteristic features of urinary retention with overflow incontinence?

Answer 12

Poor urine flow, double voiding, post micturition dribbling
Blockage to urethra
Older men with benign prostatic hypertrophy

Question 13

What are treatment options for urinary retention with overflow incontinence?

Answer 13

Alpha blocker
Anti-androgen
Surgery -Trans-urethral resection of prostate
Catheterisation

Question 14

What is urge incontinence?

Answer 14

Bladder muscles too strong

Question 15

What are characteristic features of urge incontinence?

Answer 15

Detrusor contracts at lower volumes
Sudden urge to pass urine immediately
Patients often know every public toilet
Can be caused by bladder stones or stroke

Question 16

How is urge incontinence treated?

Answer 16

Anti-muscarinics to relax detrusor

Bladder re-training

Question 17

What is neuropathic bladder?

Answer 17

Underactive bladder

Question 18

What are characteristic features of neuropathic bladder?

Answer 18

Secondary to prolonged catheterisation
Secondary to neurological disease ie MS
No awareness of bladder filling resulting in overflow incontinence

Question 19

How can we assess incontinence?

Answer 19

Careful history/social history
Assess fluid intake and urine output
General examination to include rectal and vaginal examination
Urinalysis and MSSU
Bladder scan for residual volume
Consider referral to incontinence clinic
Suggest lifestyle changes and stopping unecessary drugs
Consider physio/medical/surgical treatment

Question 20

What are indications for referral to incontinence specialists?

Answer 20

Failure of initial management after 3 months - pelvic floor exercises, cone therapy, etc