Incontinence Flashcards
What are some features a CGA assesses?
Functional capacity (ADLs)
Falls
Risk
Cognition
Mood
Poly pharmacy
Social support
Financial concerns
Goals of care
What are some basic ADLs?
Bathing
Dressing
Toileting
Maintaining continence
Feeding
Grooming
What are some advanced ADLs?
Fulfilling family roles and community roles
What is the reflex process of voiding/micturition?
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
How do we prevent voiding/micturition?
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
How is urine stored in the bladder reflex?
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
What general issues can lead to urinary incontinence?
Defective nerve pathways
Abnormal muscle tone to detrusor, sphincters or pelvic floor
Obstructions
What are the 7 types of incontinence?
Functional
Stress
Urge
Mixed
Overactive bladder. Syndrome
Overflow
True
What are some risk factors for developing urinary incontinence?
Pregnancy
Child. Birth
Hysterectomy
Post menopausal
Prostate enlargement
Stroke
Dementia
Parkinson’s
Constipation (pressure on bladder)
What is functional urinary incontinence?
Patient unable to reach toilet due to poor mobility or unfamiliar surroundings
What is stress incontinence?
When there’s an increase in intrabdominal pressure like a cough or sneeze and leads to involuntary leakage of urine (weak urinary outlet)
What is urge incontinence?
Feel the sudden need to go and cant hold it due to the. High pressure in the bladder
What is mixed incontinence?
Mixture of both stress incontinence and urge incontinence
What is overactive bladder syndrome?
When the patient has urgency that occurs with or without h urge incontinence and usually with. Frequency or nocturia
What is overflow incontinence?
Chronic bladder outflow obstruction occurs, eventually. Pressure builds up high enough to force urine out slowly
What is true incontinence?
Continuous leakage of urine likely due to a fistulous track between the vagina and the ureter or bladder or urethra
When doing an incontitnence history, what are some questions you want. To ask?
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?
What are some simple incontinence questions to ask?
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)
What investigations do you do for incontinence?
Urine dip
Bladder scan pre and post void (should be more than 10% retention)
Urine flow andurodynamics
What do you examine with urinary incontinence?
Vaginal exam (atrophy? Prolapse?)
Rectal exam (constipation? Prostate enlargement? Anal tone?)
