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4.3. Intergrated Care > Incontinence > Flashcards

Incontinence Flashcards

1
Q

Outline the possible storage symptoms of urinary incontinence

A

Frequency

Urgency

Nocturia

Incontinence

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2
Q

Outline the possible voiding symptoms of urinary incontinence

A

Slow stream

Spitting/spraying

Intermittency

Hesitancy

Straining

Terminal dribble

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3
Q

Outline the possible post-micturition symptoms of urinary incontinence

A

Post-micturition dribble

Feeling of incomplete emptying

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4
Q

Outline overflow incontinence

A

Involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate

Neural lesion = between S2-S4

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5
Q

Outline the predisposing risk factors relating to urinary incontinence

A

Co-morbidities

Obesity

Age

Increased intra-abdo pressure

UTI

Drugs

Menopause

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6
Q

Briefly outline the investigations used to aid diagnosis of urinary incontinence

A

Urine dipstick/MSU = UTI, haematuria, proteinuria, glucosuria

Frequency-volume chart

Bladder diary

Post-void bladder scan – in pts with voiding dysfunction

Pressure-flow studies +/- video

Pad tests

Cystoscopy

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7
Q

What lifestyle modifications can help address urinary incontinence?

A

Modify fluid intake

Weight loss

Stop smoking

Decrease caffeine intake

Avoid constipation

Timed voiding

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8
Q

Outline treatment options for pts unsuitable for surgery and who have failed conservative management

A

Indwelling catheter = indwelling, suprapubic

Sheath device = adhesive condom attached to catheter tubing and bag

Incontinence pads

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9
Q

What is the initial management for stress urinary incontinence?

A

Pelvic floor muscle training

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10
Q

What are the male and female surgery options for stress urinary incontinence?

A

Females = low tension vaginal tapes, intramural bulking agents

Males = artificial urinary sphincter, male sling procedure

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11
Q

How is urge urinary incontinence initially managed?

A

Bladder training = schedule of voiding

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12
Q

What is the pharmacological management for urge urinary incontinence?

A

1st Anticholinergics = act on muscarinic receptors M2 and M3 (oxybutynin, tolteridone)

2nd Beta-3 adrenoceptor agonist = increases bladders capacity to store urine (mirabegron)

Vaginal oestrogen = vaginal atrophy

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13
Q

What are the surgical options when treating urge urinary incontinence?

A

Sacral N neuromodulation

Autoaugmentation

Urinary diversion

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14
Q

What questions are important during an incontinence Hx?

A
  • storage symptoms
  • voiding symptoms
  • pain, dysuria, haematuria
  • childhood symptoms
  • bowel function/frequency
  • PMH
  • surgery
  • Obs+Gynae Hx
  • Med review
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15
Q

What factors are important during an incontinence exam?

A

CVS = signs of chronic disease

Cognition = AMT

Neuro = gait, dorsiflexion of toes (S3), perineal sensation (L1-L2), sensation of the sole (S1), sensation of posterior thigh (S3)

Abdo = masses, enlarged kidneys, distended bladder

DRE = anal tone, constipation, rectal mass, prostate

Pelvis = vaginal atrophy, prolapse

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16
Q

What are the reversible causes/contributing factors to urinary incontinence?

A 
Fluid intake
UTI
Function - poor mobility, visual impairment, poor dexterity, risk of falls
Medication
Smoking 
Atrophic vaginitis
DM
Chronic constipation
17
Q

What medications/drugs can potentially worsen UI?

A

Diuretics, anti-cholinergic, caffeine, alcohol, beta-blockers/CCB (relax sphincters)

18
Q

What are the similarities and differences between men and women regarding UI?

A

Women – urge more common, obstetric Hx

Men – prostate

19
Q

What is the most common cause of UI in the elderly?

A

Infection

20
Q

What medication should not be prescribed in the elderly for urinary incontinence, what can be prescribed instead?

A

OXYBUTANIN
- urinary retention, falls, confusion

Instead = MIRABEGRON

21
Q

When a patient is presenting with urgency, dysuria, burning what Dx should you be thinking of?

A

Atrophic vaginitis

Pale vaginal wall = lack of oestrogen = low flora = inflam

Mx = vegifet (topical oestrogen)

22
Q

What key areas should be explored in a continence assessment?

A

Detailed continence Hx

Review bladder/bowel diary

Abdo exam

Urine dipstick / MSU

PR exam including prostate exam in males

External genitalia review (atrophic vaginitis in females)

Post micturition bladder scan

23
Q

What key areas need to be addressed when managing incontinence?

A

Switch to decaffeinated drinks

Good bowel habit

Improving oral intake

Regular toileting

Pelvic floor exercises and bladder retraining

Oxybutanin (younger pt not older)

MIRABEGRON - older pts

4.3. Intergrated Care (13 decks)

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