Incontenance and Constipation Flashcards
According to a WHO survey in 1998, 200 million people worldwide have bladder control problems. Are older men or women more likely to experience continence (controlling their bladder) problems?
- women
- 2 in 5 women over 60/y/o
Urine filters from the kidneys down to the bladder through the ureters and then is removed from the bladder via the urethra. What is the name of the special type of muscle that the bladder is composed of?
1 - psoas muscle
2 - detrusor muscle
3 - inguinal muscle
4 - pelvic muscle
2 - detrusor muscle
- this is able to stretch as the bladder fills
What type of cells are contained within the bladder that allows the bladder to stretch?
1 - stratified transitional epithelial cells
2 - stratified columnar cells
3 - pseudostratified squamous epithelial cells
4 - squamous epithelial cells
1 - stratified transitional epithelial cells
Roughly how much urine can the bladder store?
1 - 100-200ml
2 - 200-300ml
3 - 500-750ml
4 - 1000-2000ml
3 - 500-750ml
- slightly less in women as the uterus takes up space
The bladder contains an internal and external sphincter. Which one is autonomous and not under our control?
- internal sphincter
- composed of smooth muscle and opens when the bladder is half full
The bladder contains an internal and external sphincter. Is the external sphincter composed of smooth or skeletal muscle?
- skeletal muscle
- under voluntary control and allows us to stop urine flow by contracting called Kegel exercises
When the bladder begins to fill, stretch receptors sends a signal to the spinal cord, called the micturition centre. What level is this at in the spinal cord?
1 - L4-L5
2 - L5-S2
3 - S1-S2
4 - S2-S4
4 - S2-S4
When the micturition centre in the spinal cord is stimulated at S2-S4 by stretch receptors in the bladder, does this affect the sympathetic or parasympathetic system?
- both
- part of micturition reflex
- decreases sympathetic and increased parasympathetic
When the micturition centre in the spinal cord is stimulated at S2-S4 by stretch receptors in the bladder this reduces the sympathetic and increases the parasympathetic activity, all part of the micturition reflex. Does this cause the detrusor muscle to contract or relax?
- contract as in rest and digest = parasympathetic
When the micturition centre in the spinal cord is stimulated at S2-S4 by stretch receptors in the bladder this reduces the sympathetic and increases the parasympathetic activity, all part of the micturition reflex. Does this cause the internal sphincter to contract or relax?
- relax and allow urine to leave the bladder
- as in rest and digest = parasympathetic
- has a moderate effect on relaxing the external sphincter as well
When the bladder begins to fill, stretch receptors sends a signal to the spinal cord, called the micturition centre in the sacrum at S2-S4. These is also a signal sent to the brain, specifically which part of the brain?
1 - hippocampus
2 - pons
3 - midbrain
4 - medulla
2 - pons
- pontine micturition centre
- pontine storage centre
If we want to urinate does the pontine micturition centre or pontine storage centre override the micturition reflex and stop us from urinating?
- pontine storage centre
- as in it stores the urine
- if we want to urinate the pontine micturition centre allows for the micturition reflex to occur
Which nerve is important for being able to contract the external sphincter and thus control when to urinate?
1 - hypogastric nerve
2 - sciatic nerve
3 - pudendal nerve
4 - superior gluteal nerve
3 - pudendal nerve
There are lots of different types of incontenance. What is urge incontenance?
1 - small leakage of urine occurs on physical exertion due to stress on bladder
2 - unable to control urination due to involuntary bladder contractions and then urination
3 - urethra and flow of urine is blocked
4 - both urge and stress incontenance
5 - bladder fills but does not empty properly causing continuous dribbling
2 - unable to control urination due to involuntary bladder contractions and then urination
- Idiopathic (most common)
- Neurogenic
- Infective
- Bladder outlet obstruction
There are lots of different types of incontenance. What is stress incontenance?
1 - small leakage of urine occurs on physical exertion due to stress on bladder
2 - unable to control urination due to involuntary bladder contractions and then urination
3 - urethra and flow of urine is blocked
4 - both urge and stress incontenance
5 - bladder fills but does not empty properly causing continuous dribbling
1 - small leakage of urine occurs on physical exertion due to stress on bladder
Risk factors:
- female gender
- age
- previous pelvic surgery
- neurological disease
- UTI
- post-menopausal
- post-hysterectomy
- bladder outlet obstruction
There are lots of different types of incontenance. What is mixed incontenance?
1 - small leakage of urine occurs on physical exertion due to stress on bladder
2 - unable to control urination due to involuntary bladder contractions and then urination
3 - urethra and flow of urine is blocked
4 - both urge and stress incontenance
5 - bladder fills but does not empty properly causing continuous dribbling
4 - both urge and stress incontenance
There are lots of different types of incontenance. What is outflow incontenance?
1 - small leakage of urine occurs on physical exertion due to stress on bladder
2 - unable to control urination due to involuntary bladder contractions and then urination
3 - urethra and flow of urine is blocked
4 - both urge and stress incontenance
5 - bladder fills but does not empty properly causing continuous dribbling
3 - urethra and flow of urine is blocked
- almost always occurs in men
- phimosis
- benign prostate hyperplasia, stricture, trauma, blood clot, calculi, cancer of the bladder, prostate, cervix or colon, STIs (particularly in women)
There are lots of different types of incontenance. What is overflow incontenance?
1 - small leakage of urine occurs on physical exertion due to stress on bladder
2 - unable to control urination due to involuntary bladder contractions and then urination
3 - urethra and flow of urine is blocked
4 - both urge and stress incontenance
5 - bladder fills but does not empty properly causing continuous dribbling
5 - bladder fills but does not empty properly causing continuous dribbling
- continuous dribbling or symptoms of stress incontinence with large post-void residual volume
- can be caused by recurrent UTIs
- made worse by constipation or anticholinergics
- often occurs in men with prostatic obstruction
There are lots of different types of incontenance. What is functional incontenance?
1 - small leakage of urine occurs on physical exertion due to stress on bladder
2 - inability to reach and use the toilet
3 - urethra and flow of urine is blocked
4 - both urge and stress incontenance
5 - bladder fills but does not empty properly causing continuous dribbling
2 - inability to reach and use the toilet
- may be due to frailty or disability
All of the following are causes that can accentuate a patients incontenance, EXCEPT which one?
1 - bowel function (constipation)
2 - mobility/dexterity (unable to reach the toilet)
3 - medication
4 - nutrition
5 - medical conditions
6 - psychological conditions
4 - nutrition
- most of these causes can be treated if clinician is aware of them
When conducting a history with a patient, in reference to their urination habits, which of the following are RED flags to be aware of?
1 - Haematuria
2 - Persistent UTI
3 - Constitutional symptoms
4 - Poor renal function
5 - Abnormal neurology include saddle anaesthesia
6 - Recent back trauma or pelvic surgery
7 - all of the above
7 - all of the above
When managing a patient with urinary incontenance the treatment can be divided into 4 sections:
- Lifestyle advice/patient education
- MDT/non-pharmacological
- Medical management
- Surgical management
Which of the following is NOT a lifestyle intervention for incontenance?
1 - Smoking cessation
2 - Reduced fluid intake at specific times
3 - Weight reduction
4 - Managing constipation
5 - Reduce alcohol and caffeine intake
6 - Botulinum toxin
6 - Botulinum toxin
- limits detrusor muscle contractions
In some patients the use of anti-muscarinics can be used. These act by competitively binding against ACh, therefore reducing parasympathetic activity and detrusor muscle contraction. Which of the following is the core anti-muscarinic that we need to be aware of used to treat urinary incontenance?
1 - bisoprolol
2 - doxazosin
3 - digoxin
4 - solifenacin
4 - solifenacin
Solifenacin an anti-muscarinics that competitively binds against ACh, reducing parasympathetic activity and detrusor muscle contraction. However, it has a large adverse events profile, especially in the elderly. Which of the following are common?
1 - cognitive impairment, hallucinations
2 - blurred vision
3 - dry mouth
4 - tachycardia
5 - nausea, constipation
6 - urinary retention
7 - all of the above
7 - all of the above
- all are associated with the inhibiting the parasympathetic system
In males who experience benign prostate hyperplasia (BPH), medications can limit this. Which drug is typically prescribed for this, and is a core drug for us?
1 - bisoprolol
2 - doxazosin
3 - digoxin
4 - solifenacin
2 - doxazosin
- tamsulosin is also common
- both are alpha blockers that reduces smooth muscle tone in the prostate
- transurethral resection of the prostate (TURP) is also a surgical option for BPH
Constipation is very common in elderly patients. How long does constipation have to be present to be diagnosed as chronic constipation?
1 - 2 weeks
2 - 4 weeks
3 - 8 weeks
4 - 12 weeks
4 - 12 weeks
- >3 months essentially
All of the following are causes of constipation, EXCEPT which one?
1 - reduced mobility
2 - low in fibre
3 - peptic ulcers
4 - poor oral fluid intake
5 - neurological disorders (parkinsons, spinal cord injury,
6 - GI conditions (coeliac disease)
7 - medications (opioids, iron supplements)
3 - peptic ulcers
Typically in older patients, the diagnosis of constipation is less than how many bowel movements in 1 week?
1 - <10
2 - <7
3 - <5
4 - <3
4 - <3
Elderly patients typically present with which of the following symptoms if they have constipation?
1 - Confusion, delirium, functional decline
2 - Nausea or loss of appetite
3 - Overflow diarrhoea
4 - Urinary retention
5 - abdominal pain
6 - distention/bloating
7 - all of the above
7 - all of the above
When performing a history with a patient, which of the following is NOT a RED flags to be aware of?
1 - overflow diarrhoea
2 - sudden change in bowel habit
3 - rectal bleeding/bloody stools
4 - weight loss
5 - abdominal pain
6 - iron-deficiency anaemia
1 - overflow diarrhoea
Some basic lifestyle advice for patients with constipation is increased fluid intake, high fibre diet, increase activity and encourage mobilisation. However, if this is infective we can perform which of the following?
1 - enema
2 - suppositories
3 - disimpaction
4 - all of the above
4 - all of the above
There are lots of oral laxatives that can be given, such as the ones below. However, which one MUST NOT be given in opioid constipation?
1 - bulk-forming laxatives
2 - osmotic laxative
3 - stimulant laxative
4 - stool softener
1 - bulk-forming laxatives
- Ispaghula husk
- osmotic laxative = Lactulose, Macrogol
- stimulant laxative = Senna, glycerol suppositories
- stool softener = Docusate sodium
