Incontinence

Question 1

What are some features a CGA assesses?

Answer 1

Functional capacity (ADLs)
Falls
Risk
Cognition
Mood
Poly pharmacy
Social support
Financial concerns
Goals of care

Question 2

What are some basic ADLs?

Answer 2

Bathing
Dressing
Toileting
Maintaining continence
Feeding
Grooming

Question 3

What are some advanced ADLs?

Answer 3

Fulfilling family roles and community roles

Question 4

What is the reflex process of voiding/micturition?

Answer 4

Parasympathetic control
Stretcher receptors in bladder detrusor muscle detect full bladder
Impulses sent to M centre (micturition centre)
This stimulates parasympathetics to send signals to the M3 receptors in the bladder leading to detrusor muscle contraction

Question 5

How do we prevent voiding/micturition?

Answer 5

Cerebral cortex neurones inhibit the M centre preventing signals being sent to the M3 receptors reverting detrusor contraction when want to consciously prevent voiding. M centre sends inhibitory impulses to. M3

Question 6

How is urine stored in the bladder reflex?

Answer 6

Bladder stretches (signal enters at S2-S4
Synapses to sympathetics that. Go to B3 in the bladder and inhibit contraction and stimualtes contraction of internal sphincter at alpha 1

L centre also stimulates contraction of external urethral sphincter via pudenal nerve

Question 7

What general issues can lead to urinary incontinence?

Answer 7

Defective nerve pathways
Abnormal muscle tone to detrusor, sphincters or pelvic floor
Obstructions

Question 8

What are the 7 types of incontinence?

Answer 8

Functional
Stress
Urge
Mixed
Overactive bladder. Syndrome
Overflow
True

Question 9

What are some risk factors for developing urinary incontinence?

Answer 9

Pregnancy
Child. Birth
Hysterectomy
Post menopausal
Prostate enlargement

Stroke
Dementia
Parkinson’s
Constipation (pressure on bladder)

Question 10

What is functional urinary incontinence?

Answer 10

Patient unable to reach toilet due to poor mobility or unfamiliar surroundings

Question 11

What is stress incontinence?

Answer 11

When there’s an increase in intrabdominal pressure like a cough or sneeze and leads to involuntary leakage of urine (weak urinary outlet)

Question 12

What is urge incontinence?

Answer 12

Feel the sudden need to go and cant hold it due to the. High pressure in the bladder

Question 13

What is mixed incontinence?

Answer 13

Mixture of both stress incontinence and urge incontinence

Question 14

What is overactive bladder syndrome?

Answer 14

When the patient has urgency that occurs with or without h urge incontinence and usually with. Frequency or nocturia

Question 15

What is overflow incontinence?

Answer 15

Chronic bladder outflow obstruction occurs, eventually. Pressure builds up high enough to force urine out slowly

Question 16

What is true incontinence?

Answer 16

Continuous leakage of urine likely due to a fistulous track between the vagina and the ureter or bladder or urethra

Question 17

When doing an incontitnence history, what are some questions you want. To ask?

Answer 17

How able are you to get to the toilet? Is it near by?
Fluid balance: caffeine? Alcohol? Increased nocturnal diuresis CCF? Drugs causing oedema? Diuretics?
Urethral closure: obese? Chronic cough?
Bladder contractile strength: meds impairing (anticholinergics? Opiates? CCB?)
CNS disease? Diabetes?
Bladder. Stones? Cancer?

Question 18

What are some simple incontinence questions to ask?

Answer 18

Leak when cough or sneeze? (Stress)
Cant reach toilet in time? (Urge)
Frequency in the day or night?
Dribbling?
Loss of bladder control?
Incomplete emptying?
Dysuria?

Bowel habits
Sexual dysfunction. (Autonomic neuropathy and. Diabetes)

Question 19

What investigations do you do for incontinence?

Answer 19

Urine dip
Bladder scan pre and post void (should be more than 10% retention)
Urine flow andurodynamics

Question 20

What do you examine with urinary incontinence?

Answer 20

Vaginal exam (atrophy? Prolapse?)
Rectal exam (constipation? Prostate enlargement? Anal tone?)