Urinary and faecal incontinence Flashcards
what age related factors can contribute to urinary incontinence?
decreased total bladder capacity but increased residual volume
decreased contractile functioning
loss of pelvic floor and spinchter muscles
hypertrophy of prostate
what cormorbidities can contribute to urinary incontinence?
decreased mobility
medications
increased constipation
impaired cognition
what drugs contribute to UI?
diuretics
Anticholinergics
sedatives
what reversible factors can cause UI?
UTI Delirium Constipation Poluria in DM, hypercalcaemia Prolapse in women Bladder stones and tumours
what are urgency symptoms of UI?
Frequent voiding Strong urge and decreased time to reach toilet Wet overactive bladder Nocturnal incontinence Detrusor muscle overacitivty
what are stress symptoms of UI?
small vol leaks when coughing, laughing, lifting etc
often coexists with urge symptoms
what are obstructive symptoms in UI?
decreased force of stream
hesitancy
Intermittent flow
what investiagtions are useful in UI?
MSSU and urinalysis cough or empty supine stress test post void residual measurement General blood tests and PSA Bladder diary
what management options are available for UI?
overactive bladder
- bladder retraining
- regular toileting
- Anticholinergics e.g oxybutynin, solifenacin, tolterodine
Stress incontinence
- pelvic floor exercises
- colposuspension
- tension free vaginal tape
intermittent catherisation
synthetic vasopressin
Drainage sheath or condom catheter
what are the causes of faecal incontinence?
sphincter laxity severe haemorrhoids rectal prolapse tumours constipation (overflow) IBD GI infections LMN lesions and SCI Cognitive impairment
what may indicate faecal impaction in a history?
feeling of fullness with constant seepage of semi liquid faeces
urinary and faecal incontinence
what investigations are done in faecal incontience?
PR - anal tone, impacted faeces and masses
AXR - faecal loading
sigmoidoscopy - haemorrhoids, IBD, mass
Anorectal mamometry
what treatment options are available for faecal incontinence due to constipation and overflow?
isphagula husk phosphate enema laxative - lactulose = softener - senna = stimulant irrigation
what treatment options are available for neurogenic faecal incontinence?
irrigation
antidiarrhoeal meds - loperamide, codiene phosphate
laxatives and enema
sacral nerve stimulation
how can incontinence due to sphincter issues be treated?
antidiarrhoeal meds
sphincter repair
neosphincter
