Incontinence Flashcards
What are the risk factors for male incontinence?
Constipation Prostate enlargement Infections Functional impairment Cognitive impairment - stroke, dementia Prostatectomy
How would you investigate male incontinence?
DRE - prostate
Digital anal assessment of pelvic floor strength
Urine dip
Post void bladder scan - residual volume
Urinary flow rates - neurological cause suspected
When would you refer some to secondary care for male incontinence?
LUTS +
- Recurrent/persistent UTI
- Retention
- Renal impairment
How is male incontinence managed temporarily?
Containment devices
What is the management for stress incontinence?
Pelvic floor exercises
Intramural bulking agents
Can use male slings but limited evidence
How is incontinence managed post prostatectomy?
Pelvic floor exercises
How is mixed incontinence managed?
Pelvic floor exercises
Antimuscarinics - avoid oxybutynin! - affect cognition, constipation and retention
How is cognitive dysfunction induced incontinence managed?
Follow a timed toilet programme
What are the types of catheters used for male incontinence?
Indwelling (urethral)
Suprapubic - lower rates of UTI’s and urine bypassing
When are indwelling catheters used?
Chronic retention
Skin wounds contaminated with urine
Distress and disruption caused by incontinence
Unable to perform self-catheterisation
How is benign prostatic hyperplasia managed?
Alpha-antagonist:
- Decreased smooth muscle tone
- ADR - postural hypo, dry mouth, depression
5-alpha-reductase inhibitors
- Reduce prostate volume
- ADR - don’t improve symptoms for 6 months, erectile and ejaculation dysfunction, decreased libido, gynaecomastia
What should be considered in the management of faecal incontinence in the frail population?
Diet - optimised depending on stool consistence
Access - easily removable clothing & access
Continence products
Rapid access toilet card
Anal plugs
Skin care
Avoid straining
Pharmacy review - meds that cause incontinence
Psychological and emotional support
What medication would you offer for faecal incontinence?
Loperamide hydrochloride
Anti-diarrhoeal
Only use once other causes of diarrhoea have been excluded
What secondary care must be considered for faecal incontinence?
Pelvic floor muscle training
Dietary assessment
Bowel retraining
Surgical - stoma, sphincter repair, sacral nerve stimulation
