Geriatrics 3 - continence

Question 1

Who is affected by incontinence?

Answer 1

3x more in women

living in institution eg care home

Question 2

Causes of incontinence (broad)

Answer 2

extrinsic to urinary system
intrinsic to urinary system
often a bit of both

Question 3

Extrinsic factors of incontinence

Answer 3

co-morbidities 
diuretics 
constipation 
home circumstances 
social circumstances 
drinking too much 
confusion 
reduced mobility

Question 4

Volume the bladder can store

Answer 4

400-600ml

Question 5

Parasympathetic innervation of bladder

Answer 5

S2-4, muscle contractions

Question 6

Sympathetic innervation of bladder

Answer 6

T10-L2 - B adrenoceptor relax detrusor

T10-S2 - a adrenoceptor contract neck of bladder and internal urethral sphincter

Question 7

Somatic innervation of bladder

Answer 7

S2-4 = contract pelvic floor muscles and EUS

Question 8

location of micturition centre

Answer 8

pons

Question 9

Bladder outlet too weak

Answer 9

stress incontinence

Question 10

stress incontinence features

Answer 10

urine leak on movement, cough laugh
women, menopause, childbirth
weak pelvic floor muscles

Question 11

Treating stress incontinence

Answer 11

physio, oestrogen cream, duloxetine

TVT/colposuspension

Question 12

Bladder outlet too strong

Answer 12

urinary retention with overflow incontinence

Question 13

urinary retention with overflow incontinence features

Answer 13

poor urine flow, terminal dribbling, voiding, hesitancy

blockage to urethra, BPH

Question 14

Treating urinary retention with overflow incontinence

Answer 14

alpha blocker (Tamsulosin) relax sphincter
anti androgen (finasteride) shrink prostate 
TURP
catheterisation = suprapubic

Question 15

bladder muscles too strong

Answer 15

urge incontinence

Question 16

features of urge incontinence

Answer 16

detrusor contracts at low volumes

sudden urge and may be caused by bladder stones or stroke

Question 17

treating urge incontinence

Answer 17

anti-muscarinics

bladder retraining

Question 18

beta 3 adrenoreceptor agonist role

Answer 18

relax detrusor

Question 19

underactive bladder also known as?

Answer 19

neuropathic bladder

Question 20

Neuropathic bladder features

Answer 20

rare
secondary to stroke or MS
secondary to prolonged catheterisation
no awareness of bladder filling - overflow incontinence

Question 21

Treating neuropathic bladder

Answer 21

parasympathetics??

catheterisation

Question 22

assessing incontinence

Answer 22

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

Question 23

When would you refer to incontinence specialist?

Answer 23

failed initial management - 3 months of vaginal cones, PFMT, habit retraining or medication
vesico-vaginal fistula, CNS, gynaecological, prostate cancer etc

Question 24

When would you refer faecal incontinence?

Answer 24

failed initial management or initially if sphincter damage or CNS disease

Question 25

If all else fails what else can be used?

Answer 25

incontinence pads
urosheath
catheter (intermittent, long term, suprapubic)