Incontinence Flashcards
2 types of incontinence
- Urinary
- Faecal
4 types of urinary incontinence
- Stress incontinence
- Urge incontinence
- Chronic retention
- Functional incontinence
Mixed = stress and urge
Define stress incontinence
- Leak small amounts of urine during activities that increase pressure inside the abdomen - coughing, sneezing, laughing, sport
Epidemiology - stress incontinence
- M < F
- Women - pregnancy and menopause
- Men - after prostate surgery
- Higher risk in diabetics, chronic cough, constipation, obesity
Define urge incontience
- Also called UNSTABLE or OVERACTIVE bladder
- Sudden urge to urinate
- Detrusor instability
- Bladder feels fuller than it actually is = contracts to early = may leak urine
- Noturia
Epidemiology urge incontience
- More common in the elderly
- Symptoms worsen with stress, caffeine and alcohol
Urge incontinence is linked to what conditions
- Parkinson’s
- MS
Conditions that interfere with the brain’s ability to send messages to the bladder via the spinal cord
- Constipation
- Enlarged prostate
- Long history of poor bowel habits
Define chronic retention incontinence
- Bladder unable to empty properly
= Results in frequent leakage of small amounts of urine
Symptoms/signs of retention incontinence
- Strain to pass urine
- Weak or slow urine stream
- Feeling of not empty bladder
- Little/no warning when needing to pass urine
- Urinating while asleep
- Frequent UTIs/cystitis
- Dribbling urine after voiding
Causes of retention incontinence
- Urethra blockage caused by full bladder
- Enlarged prostate
- Pelvic organ prolapse = block urethra
- Damaged nerves - control bladder, urethral sphincter, pelvic floor muscles
- DM, MS, stroke, PD - interfere with bladder fullness sensation
- Some medications
Define functional incontinence
- Physical/intellectual/environmental issues that can be a contributing cause of incontinence in a person with normal bladder function
- eg. cannot walk to toilet, toilet hard to use, unable to communicate need to go to toilet
- Problems with walking, memory or learning
Define faecal incontinence
- Involuntary passage or flatus or faeces
Epidemiology faecal incontinence
- Common - affect ~10% adults
- Most common in elderly, women who have given birth, people with cognitive impairment or neurological disorders
- 50% institutionalised patients
Causes of faecal incontinence
- Obstetric injury - direct muscle damage or neuropathy due to pelvic nerve damage stretching during delivery
- Ageing - general pelvic muscle/tissue deterioration
- Surgery to pelvic floor
- Neurological disorders
- Anorectal structural abnormalities
- Cognitive/behavioural dysfunction
- Stool consistency
- General disability
- Overflow - impaction, encoparesis
- Idiopathic
Scoring systems for faecal incontinence
- Wexner score
- American medical system score
- Vaizey score
Describe the Wexner score
- Solid/liquid/gas
- Need to wear pad
- Lifestyle alterations
- Frequency of these things occurring - never to always
Describe the American Medical System score
- Recall symptoms - last 4 weeks
- 6 frequencies
- Gas/soiling/leaking/solid/liquid/lifestyle affected
Describe the Vaizey score
- Solid/liquid/gas
- Pad use
- Lifestyle alterations
- Constipating medication
- Lack of ability to defer defecation 15 minutes
Treatment for faecal incontinence
- Dietary advice
- Bowel interventions
- Antidiarrhoeal medication
- Coping startegies
- Enema
- Suppositories
