INCONTINENCE Flashcards
Causes of acute, reversible urinary incontinence?
DIAPERS Delirium Incontinence Atrophied vaginitis Pharmaceuticals Excess fluid production Restricted mobility Stool impact ion
What is incontinence?
The involuntary loss of urine, sufficient enough to cause a social of health problem
What is stress incontinence, what causes it in women/men?
Stress - increased intra-abdominal pressure which overcomes pelvic muscle/floor.
Classic story is loss of small amounts of urine.
Women - recurrent child birth/low oestrogen
Men - prostate surgery
Management of stress incontinence?
Non - pharm
- wt loss
- abdominal/pelvic floor exercises
Surg
- tension-free vaginal tape TVT aka slings
What is urge incontinence? What is it due to? Causes?
You can’t delay urinating after sensing a full bladder.
DETRUSOR OVERACTIVITY
Local conditions (cystitis, stones, obstructions) NEURO (dementia, cord, Parkinson's)
Management of urge incontinence?
Non- pharm
PFE
Bladder training (delay voiding after urge)
Pharm
- anti-cholinergics (oxybutynin)
- if Pm -> intravaginal oestrogen
- chronic catheterization last line for bed bound pts
Surg
- not usually done
What is overflow incontinence?
Inability to completely empty the bladder. Weakness of the detrusor. There is over distension of the bladder by
- anatomical obstruction (prostate, stricture)
- NEURO
- acontractile bladder (DM, cord, drugs)
- neurogenic, detrusor-sphincter dyssynergy (ms, suprasacral cord)
Management of overflow incontinence?
Non-pharm
- double void
- lean forward, elbows on knees
Pharm
- cease anti-cholinergics (because they decrease destructor activity)
- intermittent self-catheterization
Surg
- release iatrogenic obstruction (TVT sling)
- repair vaginal prolapse)
Complications of urinary incontinence?
Perineal rashes +/- ulcers
UTIs -> sepsis
Falls -> fractures
Psychological: anxiety, stigmatization, isolation
