Incontinence

Question 1

What patient factors increase the likelihood of incontinence?

Answer 1

1. Female
2. Increasing Age
3. Setting- HCElderly ward/ Nursing home much more likely for urinary incontinence (faecal doesn’t change across setting)

Question 2

What are some of the risks associated with urinary incontinence?

Answer 2

1. increased risk of hospitalization

2. Increased risk of admission to a nursing home

Question 3

What does overactive bladder mean?

Answer 3

urinary urgency+/- urge incontinence

often accompanied by urinary frequency (voiding 8 times or more in 24hours) and nocturia

Question 4

What is detrusor overactivity?

Answer 4

bladder contracts spontaneously during filling as patient attempts to avoid micturition.

Question 5

What is the pathophysiology of urinary incontinence?

Answer 5

1. Weakness of the urinary outlet which results in passing of urine due to raised abdo pressure e.g.
   coughing etc. (Stress Incontinence)
2. Failure of the bladder to store urine because of high bladder pressure (Urge Incontinence)
3. A combination of 1 and 2 (Mixed Incontinence)
4. A bladder that is overfull and overflows (Bladder outlet obstruction)
5. Abnormal communications of the urinary tract
   (Fistulae)
6. Incontinence due to more general impairment
   e.g. cognitive, functional, affective.
   (Functional)

Question 6

What is essential to maintaining continence? To do with bladder and urethra?

Answer 6

Continence is maintained so long as the urethral pressure exceeds the bladder pressure. Micturition can occur when Bladder P > urethral P.

Question 7

What are the urethral sphinchters composed of and therefore under the control of? What else assists with maintaining continence that is under conscious control?

Answer 7

IUS smooth muscle therefore controlled by autonomic activity (same as detrusor muscle which is contracted on stim of parasympathetic system)
EUS striated muscle therefore under voluntary control
Pelvic floor striated muscle.

Question 8

Why might a patient started on TCAs develop incontinence?

Answer 8

antimuscarinic SE leads to urinary retention and subsequent overflow incontinence

Question 9

What is the theory behind incontinence following surgery in a patient who is fully conscious?

Answer 9

t probably the effect of pelvic trauma and drugs leads to transient damage to the sacral nerves carrying the parasympatietic supply to the detrusor muscle. The result is retention from an atonic bladder and overflow incontinence.

Question 10

A patient with dementia presents with heavy episodic incontinence with a negative MSU, total daily output of 1300mls, 38mls of urine in their bladder after voiding. What is the cause of the incontinence?

Answer 10

Functional incontinence due to brain failure

Question 11

What is the MOA of doxazosin?

Answer 11

A1 adrenoR antagonist relaxing the muscles in the prostate and bladder neck, making it easier to urinate
SE include: Orthostatic hypotension, dizziness, fatigue, abdo disturbances.