Incontinence Flashcards
1
Q
What is the prevalence of urinary incontinence?
A
- residential care- 25%
- nursing home care- 40%
- hospital care- 50-70%
- F:M = 3:1
2
Q
What are the extrinsic causes of urinary incontinence?
A
- physical state + co-morbidities
- dec. mobility
- confusion (delerium/dementia)
- drinking too much water/at wrong time
- medication (e.g. diuretics)
- constipation
- home/social circumstances
3
Q
What is stress incontinence?
A
- bladder outlet too weak
- urine leak on movement, coughing, etc.
- weak pelvic floor muscles
- common after children/menopause
- Tx: physiotherapy, oestrogen cream, duloxetine, TVT/colposuspension
4
Q
What is urinary retention with overflow incontinence?
A
- bladder outlet too strong
- poor urine flow, double voiding, hesitancy, post micturation dribbling
- urethra blockage
- older men with BPH
- Tx: a-blocker, anti-androgen, TURP, catheterisation (often suprapubic)
5
Q
What is urge incontinence?
A
- bladder muscle too strong
- detrusor contracts at low volumes
- sudden urge to pass urine immediately
- Tx: antimuscarinics, b-3 adrenoreceptor agonists, bladder retraining
6
Q
What is a neuropathic bladder?
A
- underactive bladder
- rare
- secondary to neurological disease
- secondary to prolonged catheterisation
- no awareness of bladder filling -> urge incontinence
- Tx: parasympathomimetics (may help), catheterisation
7
Q
What are indications for referral to specialists?
A
- failure of initial management
- vesico-vaginal fistula
- palpable bladder/large residual V after micturation
- CNS disease
- certain gynaecological conditions (e.g. fibroids, procidentia, rectocele, cystocele)
- severe BPH/prostatic carcinoma
- had previous surgery for incontinence
8
Q
What are indications for referral to specialists for faecal incontinence?
A
- failure of initial management
- contipation/diarrhoea with normal sphincter
- suspected sphincter damage
- neurological damage
9
Q
What are other options after failures of treatment?
A
- incontinence pads
- urosheaths
- intermittent catheterisation
- long term urinary catherter
- suprapubic catherter
