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HCoLL > Incontinence > Flashcards

Incontinence Flashcards

1
Q

What is the epidemiology of incontinence (3)

A

1 in 30 worldwide
40% women >60
50% in care

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2
Q

What is the main muscle affected in stress incontinence?

A

Periurethral striated muscle

  • Normally allows for voluntary interruption of abdo pressure to prevent leakage
  • Most commonly affected mm in instrumental childbirth
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3
Q

Why are women more prone to stress incontinence? (2)

A

Bladder outlet weaker due to shorter urethra/no prostate

Childbirth esp forceps → lig/nn damage

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4
Q

What are some other RFs for stress incontinence (8) (other than being a woman)

A

Obesity (strain/pelvic floor weaker)
Age
Post menopausal

Surgery
Post hysterectomy

UTI
Bladder outlet obstrn (e.g. prostate)
Neuro disease

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5
Q

What is urge incontinence?

What is the basic physiology behind it?

A

Involuntary urine leakage w. sense of urgency

Detrusor instability/ Hyperreflexia → invol contraction

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6
Q

What are some causes of urge incontinence? (4)

A

Idiopathic - commonest
Infective - UTI
Neuro - MS/Parksinsons/Stroke/SC injury
Bladder outlet obstrn (e.g. prostate)

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7
Q

What are the diff types of incontinence (7)

A 
Stress
Urge
Mixed (urgency/exertion)
Functional (mobility reaching toilet in time)
Overflow (freq/noct/retention)
Detrusor overactivity
Overactive bladder
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8
Q

What elements of incontinence may be present in prostatism (3)

A

Urinary retention + Overflow
Outlet obstrn
Retention has irritant effects → detrusor instability

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9
Q

What nerve fibres/roots are involved in micturition?

Describe the interface b/wn parasymp/symp control in micturition

A

Parasymp + pudendal nn (somatic) = S2-4
Sympathetic = T11-L2

Sympathetic neck contraction → allows filling
Voiding depends of parasymp - opening bladder neck
FOLLOWED BY
Voluntary EUS relaxation

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10
Q

List some causes of bladder outlet obstrn (11)

A

Benign prostate hypertrophy (BPH)
Prostate cancer
Phimosis
Stricture (male predom)

Cervical cancer

Bladder cancer
Colon cancer
Calculi
STDs
Trauma
Blood clot
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11
Q

What is Overactive Bladder? (OAB)

A

Syndrome of urgency ± urge incontinence
Usually + frequency/nocturia
Assoc w. detrusor overactivity

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12
Q

What is the epidemiology of BPH in men?

A

40% >60s + 75% >80s

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13
Q

List some organic causes for transient incontinence

DIAPERS

A 
Delirium
Infection
Atropic (vag/urethritis)
Pharm
Excess urine
Restricted mobility
Stool impaction
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14
Q

List some medication RFs for urinary incontinence (OD AAAACCH) + why

A

Opiates
Diuretics

Alpha-adreno blockers
Alpha agonists
ACEis
Antipsychotics

Cholinesterase inhibs
Ca chan blockers
Hypnotics

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15
Q

What are some of the urinary storage Sx that should be asked for in the Hx (6)
+ Voiding Sx (5)

A 
Storage Sx: 
Continual urine loss
Frequency micturition (≥8/d)
Nocturia (≥3/night)
Urge incontinence
Stress incontinence
Voiding Sx:
Hesitancy
Intermittent stream
Incomplete emptying
Terminal dribbling
Post-micturition dribble
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16
Q

What co-morbiditities should be asked about in the PMH in incontinence (9)

A

Dementia
Stroke
MS
PD

CCF
Chronic lung disease
DM

MSk disease
Pelvic surg/OG Hx

17
Q

What should be included O/E in incontinence (6)

A

Cognition
Neuro: dorsiflexion + sensation posterior thigh (S3) + sensation sole (S1)

Abdo: kidneys/distended bladder
DRE: prostate / constipation
Pelvic: prolapse / cough
Cardioresp: CCF / chronic lung disease

18
Q

What Ix may be done in incontinence (10)

A 
Urinary diary (3d) - intake/vol passed/incontinent eps
Urinalysis (Glucose/Prot/L+Ns/Blood/MC+S)
Bloods:
U&Es
FBC (leucocytosis - infection)
Glucose 
Calcium (hypercalcaemia → constipation/confusion)

Imaging:
Post-void bladder scan (1st line- rule out chronic retention)
Only if indicated:
USS Abdo - obstr uropathy/renal failure
CT Abdo - masses
CT urography - stones
IV urogram - stones (CT urography more commonly done)

19
Q

What info may be given from a urinary diary?

A

Polyuria (>2500ml/d)
Nocturia (1/3rd urine at night)
Frequent small vols = overactive (+ if with incont = urge)

20
Q

What specialist urology tests may be used in incontinence (5)

A 
Uroflowmetry
USS Cystodynamogram (flowmetry + pre/post-void scan)
Cystometry (if still uncertain after flowmetry ± USS)

Videourodynamics - saline fill bladder, pressure transducers (urethra/rectum)
Ambulatory urodynamics - same but less artificial, transducers + electronic continence pads

21
Q

What is always 1st line RE: Management in incontinence?

What red flags may → secondary referral? (4)

A

1st line always: Pt education / MDT (Non-Pharm therapy)

Red flags:
Haematuria
Painful micturition
Prolapse beyond introitus
Suspect prostate cancer
22
Q

What elements of pt education should be covered in the management of ALL types of incontinence (5)

A

Smoking
Alcohol/Caffeine
Reduce fluid intake (esp after 8pm)

Wt reduction
Manage constipation

23
Q

Describe the MDT/Medical/Surgical management of Stress Incontinence (4:1:3)

A

MDT:
Community continence advisor (assess pt in home)
Physio - pelvic floor
Pudendal nn stimulation (device; strength altered)
Vaginal cones (improve mm awareness)

Medical - SNRIs limited evidence, none recommended

Surg:
TVT / Colposuspension / Periurethral bulking agents

24
Q

Describe the MDT/Medical/Surgical management of Overactive Bladder (3:4:1)

A

MDT (must trial ≥6wks):
Community continence advisor
Physio
Behavioural Therapy - bladder retraining

Medical:
Antimuscarinics
Beta3 agonists - if probs with antimuscarinics
Intravaginal oestrogens (if vag atrophy + OAB Sx)
Botox

Surg: Sacral nn stimulation

25
Q

Describe the MDT/Medical/Surgical management of Bladder Outlet Obstrn (3:3:1)

A

MDT:
Community continence advisor
Physio
Behavioural therapy - bladder retraining

Medical:
Alpha-antagonists (doxazocin)
Alpha reductase inhibitors (block testost. conversion)
OAB drugs (antimuscarinics/b3 agonists)

Surgical:
Transurethral prostatectomy

26
Q

What are the SEs of anti-muscarinics (6)

A 
Cognitive impairment/hallucinations
Blurred vision
Dry mouth
Tachycardia
Nausea/constipation
Urinary retention

HCoLL (8 decks)

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