Geriatrics 3 - continence Flashcards
Who is affected by incontinence?
3x more in women
living in institution eg care home
Causes of incontinence (broad)
extrinsic to urinary system
intrinsic to urinary system
often a bit of both
Extrinsic factors of incontinence
co-morbidities diuretics constipation home circumstances social circumstances drinking too much confusion reduced mobility
Volume the bladder can store
400-600ml
Parasympathetic innervation of bladder
S2-4, muscle contractions
Sympathetic innervation of bladder
T10-L2 - B adrenoceptor relax detrusor
T10-S2 - a adrenoceptor contract neck of bladder and internal urethral sphincter
Somatic innervation of bladder
S2-4 = contract pelvic floor muscles and EUS
location of micturition centre
pons
Bladder outlet too weak
stress incontinence
stress incontinence features
urine leak on movement, cough laugh
women, menopause, childbirth
weak pelvic floor muscles
Treating stress incontinence
physio, oestrogen cream, duloxetine
TVT/colposuspension
Bladder outlet too strong
urinary retention with overflow incontinence
urinary retention with overflow incontinence features
poor urine flow, terminal dribbling, voiding, hesitancy
blockage to urethra, BPH
Treating urinary retention with overflow incontinence
alpha blocker (Tamsulosin) relax sphincter anti androgen (finasteride) shrink prostate TURP catheterisation = suprapubic
bladder muscles too strong
urge incontinence
features of urge incontinence
detrusor contracts at low volumes
sudden urge and may be caused by bladder stones or stroke
treating urge incontinence
anti-muscarinics
bladder retraining
beta 3 adrenoreceptor agonist role
relax detrusor
underactive bladder also known as?
neuropathic bladder
Neuropathic bladder features
rare
secondary to stroke or MS
secondary to prolonged catheterisation
no awareness of bladder filling - overflow incontinence
Treating neuropathic bladder
parasympathetics??
catheterisation
assessing incontinence
social history intake and output chart bladder scan for residual volume urinalysis and MSSU general and rectal/vaginal incontinence clinic lifestyle and behaviour physio, meds, surgery
When would you refer to incontinence specialist?
failed initial management - 3 months of vaginal cones, PFMT, habit retraining or medication
vesico-vaginal fistula, CNS, gynaecological, prostate cancer etc
When would you refer faecal incontinence?
failed initial management or initially if sphincter damage or CNS disease
If all else fails what else can be used?
incontinence pads
urosheath
catheter (intermittent, long term, suprapubic)
