LUTS in Older People Flashcards
What is urinary incontinence?
Involuntary loss of urine, which is objectively demonstrable and is a social/hygienic problem
Why may some patients with urinary incontinence not present to their GP?
Embarrassment, think it is normal part of ageing, often come to doctor with another “more important” problem
What are some challenges associated with urinary incontinence?
May be low on priority list of clinician if patient has more than one problem
Lack of confidence in interventions
Cost about 2% of NHS budget
What are some of the challenges associated with treating urinary incontinence?
Main pharmacological treatments have side effects particularly troublesome in elderly
Non-pharmacological management takes time
Is urinary incontinence a normal part of ageing?
No = should always be investigated and treated if it causing the patient distress
What part of the brain is responsible for cortical awareness of bladder fullness?
Located in the postcentral gyrus
What parts of the brain are responsible for micturition?
Initiation of micturition occurs in the precentral gyrus
Voluntary control of micturition is located in the frontal cortex
What is activated when the bladder is distended?
Sympathetic outflow (T11-L2) is activated = maintains detrusor muscle relaxation and continence
What causes voiding of the bladder in response to bladder filling?
Parasympathetic activation (S2-4) produces contraction of detrusor muscle and relaxation of internal sphincter
What are some additional elements required for continence?
Mobility, manual dexterity and cognitive ability to react to bladder filling
What changes occur in the bladder as a natural part of ageing?
Decrease in bladder capacity and urethral closure pressure
Increase in post void residual and detrusor overactivity
What are some transient causes of incontinence?
Delirium and psychological (especially depression)
Infection = urinary (symptomatic)
Atrophic vaginitis/urethritis and endocrine
Pharmaceutical/prostate and stool impaction
Restricted mobility
What are the types of incontinence?
Stress, urge, mixed, overflow and functional
What is stress incontinence?
Involuntary urinary leakage on effort or exertion, sneezing or coughing
What is urge incontinence?
Involuntary leakage accompanied by or immediately preceded by urgency
What is mixed incontinence?
Involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing
What is overflow incontinence?
Leakage owing to bladder outflow obstruction resulting in large post void residual volume
What is functional incontinence?
Incontinence resulting from an inability to reach or use the toilet in time (e.g poor mobility, cognitive impairment)
What areas should be covered when taking a history?
Urinary symptoms, bowels, mobility, containment (e.g pads), red flags, drugs, fluid intake, precipitants, previous pelvic surgery
What are some urinary symptoms that may be present?
Storage = frequency, nocturia, urgency
Voiding = hesitancy, poor urinary stream, dribbling
History of haematuria or recurrent UTIs
What are some bowel symptoms that patients may complain of?
Straining, constipation, incontinence
What additional areas should be covered when taking a history from a female patient?
Pregnancies, mode of delivery, birth weights
What are some drugs that may be associated with incontinence?
Sedatives and hypnotics, antimuscarinics, diuretics, alcohol
What should be covered in the examination?
General appearance, mobility and cognitive exam
Abdominal and pelvic examination ( especially women)
Urinalysis = only if result will change management
PR examination
