Incontinence Flashcards
How does incontinence affect the elderly?
What intrinsic factors cause intrinsic problems
It is a common, stigmatising disabling and treatable disease that affects the elderly. Most doctors aren’t good at treating it.
Bladder muscles too strong/weak
Problems with urinary outlet
What are some extrinsic causes of incontinence
Diseases reduced mobility confusion drinking too much medications e.g. diuretics constipation home circumstances social circumstances
What controls contince
Effective function of the bladder and the integrity of the neural connections that bring it under control. The CNS connections inhibit parasympathetic tone and promote bladder relaxation and hence storage of urine.
Specifically what regions are involved with the control of micturation
local innervation arises from the parasympathetic system (S2-S4) to increase strength and frequency of contractions.
T10-L2 is a B adrenoreceptor that causes the detrusor to relax
T10-S2 causes action on the alpha adrenoreceptors that allows for contraction of the neck of the bladder and the internal urethral sphincter.
S2-S4 is the somatic innervation that causes contraction of the pelvic floor muscles and external urethral sphincter. Sphincter closure is mediated by a reflex increase in alpha adrenergic and somatic activity
What questions should be asked when taking a history fro incontinence?
Careful history, allowed to use closed questioning, social history especially to identify the lifestyle effects and extrinsic factors involved
What examinations can be undertaken to assess incontinence?
Intake and output chart
General examination +rectal and vaginal
Urinalysis and MSSU
Bladder can be scanned for residual volume
What are the three types of incontinence
Bladder outlet too weak
urinary retention
urge incontinence
What occurs when the bladder outlet is too weak
Leaks on movement, coughing, laughing, squatting etc. This can be due to weak pelvic floor muscles and is common in women with children, especially after menopause.
How do you treat individuals with a weak bladder outflow?
Physiotherapym oestrogen cream, duloxetine
TVT/colposuspension
Pelvic floor exercises, vaginal cones, biofeedbacks, kegel exercises
What occurs during urinary retention incontinence
Bladder outlet is too strong, features include poor flow, double voiding, hesitancy, poor micturation, blockage of urethra.Occurs in older men with BPH.
How do you treat individuals with urinary retention incontinence
Aplpha blocker (relaxes sphincter e.g. tamsulsin)
Anti androgen (shrinks prostate e.g. finasreride)
surgery (TURP)
Catheterisation, often suprapubic
What occurs to individuals with urge incontinence
Bladder muscles are too strong, casuign the dtruor to contract at low volumes. There is a suduen urge to pass urine immediately. Patients often know every public toilet, caused by bladder stones or stroke.
How do you treat individuals with Urge incontinence
Anti muscarinics e.g oxybutinin, tolterodine, solifenacin
Bladder retraining can be helpful
What are the four main treatments used in treatment?
Antimuscarinics (relax detrusors)- oxybutinin
Beta 3 adrenoreceptors agonsist (relax detrusor)- mirabegron
Alpha- blockers (relax sphincter, bladder neck)- tamsulosin
Anti-androgen drugs (shrinks prostate)- finastreide, dutasteride
What is a neuropathic bladder
Arises from an under active bladder. It is a rare condition second to neurologcal disease, typically MS or stroke. There is not awareness of bladder filling resulting in overflow incontinece. Medical treatments are unsatisfactory but parasympathomimetrics might help. Catheterisation is the only effective treatment
