Geriatrics- Incontinence

Question 1

Is incontinence more common in men or women?

Answer 1

Women

Question 2

Give some causes of incontinence which are extrinsic to the urinary system.

Answer 2

Lots of layers if cold
Drinking too much, or at the wrong time
Medication
Reduced mobility
Confusion
Constipation
Home circumstances e.g. bathroom difficult to access

Question 4

Which medication can cause incontinence?

Answer 4

Diuretics

Question 5

What are some of the basics of intrinsic factors causing incontinence?

Answer 5

Two parts- bladder and outlet

Each may be too weak or too strong

Question 6

When may incontinence occur if the bladder outlet is too weak?

Answer 6

Urine leak on movement:

Laughing
Coughing
Squatting

->common in women after menopause

Question 7

Treatment if bladder outlet is too weak and causing incontinence?

Answer 7

Physiotherapy
Oestrogen cream
Duloxetine

Surgical options if required.

Question 8

What is recommended to strengthen the pelvic floor after childbirth?

Answer 8

Pelvic floor exercises involving contracting the pelvic floor

Question 9

How could you describe contracting the pelvic floor in exercises?

Answer 9

Stopping peeing mid-flow

Different to clenching buttocks!

Question 10

What is the only cause of incontinence which is more common in men?

Answer 10

Bladder outlet is too strong

e.g. blockage to urethra due to prostate enlargement

Question 11

What are some of the characteristics if the bladder outlet is ‘too strong’?

Answer 11

Poor urine flow
Double voiding
Hesitancy
Post micturition dribbling

Question 12

What is the treatment in the bladder outlet is ‘too strong’ e.g. due to prostatic enlargement?

Answer 12

Alpha blockers e.g. Tamsulosin
Anti-androgens e.g. finasteride (shrinks prostate)
Surgery e.g. TURP

Question 13

What happens if the bladder muscle is ‘too strong’?

Answer 13

Urge incontinence- detrusor muscle contracts at low volumes, sudden urge to pass urine immediately

Question 14

What can cause urge incontinence?

Answer 14

Usually idiopathic
Bladder stones
Strokes

->doctors can be prone to bladder stones due to not drinking enough and not going to the toilet

Question 15

Treatment for urge incontinence?

Answer 15

Anti-muscarinics to relax the detrusor muscle
Bladder retraining can be helpful

Question 16

What are the three main types of incontinence?

Answer 16

Overflow
Stress
Urge

Question 17

What can cause overflow incontinence?

Answer 17

Urethral blockage
Bladder unable to empty properly

Question 18

What can cause stress incontinence?

Answer 18

Relaxed pelvic floor
Increased abdominal pressure

Question 19

What can cause urge incontinence?

Answer 19

Bladder oversensitivity from infection
Neurological disorders

Question 20

What can cause underactive bladder?

Answer 20

Long-term catheter use as no awareness of bladder filling, resulting in overflow incontinence

Question 21

What is the only effective treatment for underactive bladder?

Answer 21

…catheterisation

But this is also a cause… yay

Question 22

If someone presents with incontinence, which examinations would you want to do?

Answer 22

Rectal and vaginal examination

->common exam question, but lecturer argues any examination would be useful e.g. if they have a cough, check the chest

Question 23

Why would you want to do a MSSU/urinalysis for incontinence?

Answer 23

UTI can cause incontinence

Question 24

Why might a scan be done for incontinence?

Answer 24

To look if any residual volume in bladder, suggests bladder outlet obstruction

Question 25

What initial things may you consider carrying out in a patient with incontinence?

Answer 25

Intake and urine output charts
Good history- especially social

Question 26

Indications for incontinence specialists?

Answer 26

Failure of initial management (max 3 months of pelvic floor exercises, cone therapy, habit retraining and/or appropriate medication)

Question 27

What are some of the indications for immediate incontinence
referrals?

Answer 27

Vesico-vaginal fistula
Palpable bladder after micturition or confirmed large residual volume of urine after micturition
Disease of the CNS
Certain gynaecological conditions (e.g. fibroids, procidentia, rectocele, cystocele)
Severe benign prostatic hypertrophy or prostatic carcinoma
Patients who have had previous surgery for continence problems

Question 28

If treatment for incontinence does not work, what are the remaining options?

Answer 28

Incontinence pads
Urosheaths
Intermittent catherization
Long term catherization
Suprapubic catheter