Incontinence Flashcards
epidemiology
40% of women >60y; overall 25-45% men 5-39% men usually 1/2 as much as a rule 2 billion or 2% of NHS budget 200m worldwide (~1 in 30); F >M increases with age: YA 20-30%, middle-age 30-40%, elderly 30-50% urinary/double: 57% HCE, 29% RH, 63% NH faecal 3/4%; catheter 17/4/13%
types - transient
DIAPPERS delirium infection atrophy pharma psych excess urine reduced mobility stool
types - established
DOUSE detrusor instability OAB/overflow urge stress functiona; everything else (cognitive, mobility, neuro)
pathophysiology
weak outlet (EUS(external urethral sphincter), PFM (pelvic floor muscle), meds)
bladder pressure
BOO (bladder outlet obstructuion)
fistulae
function/cognitive/affective
definitions
detrusor overactivity: spontaneous contraction while filling
overactive bladder: urgency + urge incontinence
overflow incontinence: constant
urge incontinence: desire + involuntary
stress incontinence: pressure/IAP (intra-abdominal pressure) -outlet closure fails
Nocturia- need to pass during night that awakens (3 or more)
nocturnal polyuria (more than third of 24hr urine output)
impact
fear of going out smell/hygiene nocturia and sleep, QoL and Fx £354m cost per year: direct and indirect (e.g. wages) emotional impact: depp/anx falls, pressure sores, infections ^Ax/CH
management
MDT/non-pharma: training, PFM exercises, continence advisor
education: weight, drinks, food
meds: anti-ACH, duloxetine (SNRI), med r/v, laxatives, vaginal Oe
surgery: TVT (tention free vaginal tape surgery), cystoplasty(increase bladders size), CS, urethral bulking (eg block hole)
Incontinence symptoms
LUTS storage symptoms; -continual loss -nocturia -frequency of micturation -stress incontinence -urgency of micturation
voiding symptoms
- hesitency
- incomplete emptying
- terminal dribbling
- post micturation dribble
- intermittent stream
HX
‘Do you have problems with your bladder or bowel’
‘Do you ever pass urine or faeces involuntarily’
-ask about specific storage/voiding symptoms
-RED FLAGS - Pain in general, Dysuria, haematuria
-ask about childhood enuresis (urge incontinence RF)
-obs and gynae history around pelvis
-Dhx
-shx - alcohol, smoking, caffeine and fluid intake
-ask about risk factors
RFs
heart failure dementia ms dm pd chronic lung disease msk disease stroke
associations from exam
cognition -AMT score Neurological -gait -dorsiflexion -leg sensation Abdo -palpate kidneys -palpate bladder -DRE (anal tone, constipation, mass and prostate) Pelvis -vaginal atrophy (muscle strngth, osxford classification 1-5 (strong)) Cardio /resp -chronic lung/heart conditions
ix
RULE out UTI first
-haematuria = urgent urologist review and cytoscopy (possiby)
-Frequency/volume charts - intake.output and when they experience incontinence
-urinalysis- glucose(dm), protein (renal fx), leukocytes/nitrites (uti), blood (stones/malignancy)
-urine MCS
-bloods; FBC (Leucocytosis (infection), U&Es (renal fx and electrolytes), glucose (dmP and calcium (hypercalcaemia, constipation, confusion)
Imagining: post void bladder scan (1st line to rule out retention), USS abdo (kidney size and uropathy), CT urography (stones), CT abdo (kidney size and uropathy), intravenous urogram (ivu - renal stones
Normal physiology
Frontal cortex = voluntary control
pontine mituration centre (midbrain) = detrusor contraction with urethral relaxation. ach released acts on M3 receptors
- parasumpathetic (scaral plexus s2-4) mediates emptying along with pudendal nerve
- sympathetic system (t11-l2) innervate smooth muscle of bladder neek for filling
DHx
TACs - anticholinergic side effects = urine retention and overflow
-periurethral striated muscle failure is most common cause in female incontinence
Dozazosin = alpha blocker therefore blocks alpha adrenergic stimulation of external urethral sphincter resultin gin decrease tone and stress invontinence
ACEi - because of cough
Causes of acute incontience
DRIP
Drugs, delirium
Retention of urine, Restricted mobility
Impaction, Infection
Polyuria, Prostatism
