Module 9 common concerns of older adult Flashcards
urinary incontinence
involunatary transient or persistent loss of urine
- stress
- urge
- mixed
- overflow
- functional
Stress incontinence
leakage of urine with any maneuvers that increase intra-abd. pressure
- coughing, sneezing
anatomic stress incontinence
hypermobility of the bladder neck
Rise in abd. pressure
-> rotation of bladder neck and urethra below pelvic floor muscles
-> sphincter being overcome
intrinsic sphincter deficiency stress incontinence
open bladder neck at rest
- mild increase in abd. pressure -> leakage
Urge incontinence
sudden, often uncontrollable sensation to void
Occur due to rise in detrusor pressure that may be a phasic contraction or poor bladder compliance
detrusor overactivity: urge incontinence
instability of detrusor muscle during bladder filling
- bladder pressures surpass sphincter and urethral pressures -> bladder neck to open and incontinence
Urge incontinence neurogenic causes
spinal cord injuries: below T11 to L1
neurologic conditions: MS, DM, spina bifida
urge incontinence poor bladder compliance
large bladder pressures seen with small increases in volume
Mixed incontinence
combo of SUI and UUI
Overflow incontinence
incomplete emptying of urine -> passive loss of small amounts of urine when bladder pressure rises.
- bladder fills beyond capacity
overflow incontinence often seen with
bladder outlet obstruction poor detrusor contractility bladder pressure > sphincter and urethral pressure BPH radical pelvic surgery neurologic issues medications
Functional/transient incontinence
pathologic conditions external to the urinary tract
- Resnick’s DIAPPERS
Resnick’s DIAPPERS
Deliriium/confused state Infection- urinary Atrophic urethritis, vaginitis Pharmaceuticals Psychological, esp. severe depression Excess urinary output: CHF, high BG Restricted mobility Stool impaction
Stress incontinence nonpharm tx
timed voiding double voiding wt loss pelvic muscle exercises pesary placement bowel management smoking cessation
Urge incontinence nonpharm tx
timed voiding double voiding voiding diary pelvic floor exercises wt reduction smoking cessation bowel managment bladder training scheduled voiding urge suppression techniques
Overflow incontinence nonpharm tx
timed voiding double voiding clean intermittent cath pessary medical therapy surgical options
Primary consitpation
normal transit
slow transit
disorders of defecation
normal transit constipation s/s
hard stools
difficulty with passage
frequency of stooling normal
slow transit constipation causes
visceral myopathy
bowel nerve abnml
- DM neuropathy
slow transit constipation s/s
infrequent defecation
slow transit through colon
disorders of defecation causes
- inability to relax the muscles
- diminished rectal muscle contraction
- reduced response to stretching in the presence of stool
disorders of defecation s/s
dec. frequency
presence of hard tool at anus
secondary constipation causes
medication: opiates
chronic diseases
psychosocial issues
secondary constipation s/s
diminished bowel muscle contraction
dec in stool moisture content
constipation tx
disorder of defecation: refer to GI
Behavior change: inc. fiber/fluid, scheduled
- Miralax
- stimulant laxatives as last resort (dependency)
