Incontinence Flashcards
Features of stress incontinence
Occurs on coughing, sneezing or on effort or exertion
Weakness of urinary outlet
Mx of stress incontinence
Reduce caffeine intake Avoid drinking excessive amounts 3 months supervised pelvic floor muscle training Surgical - colposuspension - autologous rectus fascial sling - retropubic mid-urethral mesh sling - intramural urethral bulking agents Duloxetine
Feature of urge incontinence
Sudden urgency
Increased frequency
Nocturia
Mx of urge incontinence
Bladder training
Reduce fluid intake - espcially after 8pm
Anti-muscarinic - solifenacin
Beta-3-adrenoceptor agonists - cause bladder to relax - mirabegron
Intravaginal oestrogens - for women with vaginal atrophy and over active bladder
Features of overflow incontinence
Failure to fully empty bladder causing frequent leaking
Mx of overflow incontinence
Remove obstruction
Indwelling catheter
Suprapubic catheter
Intermittent self-catheterisation
Reduce volume of prostate
- alpha adrenoceptor antagonists - doxazocin
- 5-alpha-reductase inhibitors - finasteride
Features of functional incontinence
Person unable to recognise the need to go to the toilet, locate or access a toilet, manage personal needs or recognise the toilet
Mx of functional incontinence
Dependent on personal needs
- toileting aids, easily removable clothing
- toilet visible with signs, pictures and good lighting
- toileting routine
Stages of continence examination
Review of bladder and bowel diary
Abdominal examination
Urine dipstick and MSU
PR examination including prostate assessment in male
External genitalia review - atrophic vaginitis in females
Post micturition bladder scan
Features leading to constipation in older adults
Rectum becomes more vacuous and anal sphincter can gape due to haemorrhoids and chronic constipation
Unable to exert the same intra-abdominal pressure and muscle tension to force out constipated stool
Causes of faecal incontinenc
Always pathological - should only be stool in rectum when passing stool
Overflow diarrhoea
Neurogenic dysfunction
Features of faecal loading
Soft and hard stool can fill rectum - small amount of type 1 stool or copious amounts of type 6/7 stool with no sensation Impaction can be higher up than the rectum Ix for urinary retention Faeces may be palpated in abdo exam
Mx of faecal loading
Enemas for rectal loading
Stool softeners
Stimulants
Manual evacuation if risk of perforation outweighed by positive impact on patient
Red flags with chronic diarrhoea
Unexplained weight loss Unexplained rectal bleeding Persistent blood in stool Abdo mass Rectal mass Severe abdo pain Iron deficiency anaemia Raised inflammatory markers Nocturnal or continuous diarrhoea Fever, tachycardia, hypotension and dehydration
Causes of chronic diarrheoa
Infection
- Giardia
Laxative use
Maldigestion - chronic fatty diarrhoea
