urinary incontinenc Flashcards

1
Q

What is Urinary Incontinence?

A
 Involuntary leak of urine
 More common in older adults
 Not natural consequence of aging
 Impacts quality of life
 Loss of independence
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2
Q

D.R.I.P.

A
 D – delirium, dehydration, depression
 R – restricted mobility, rectal impaction
 I – infection, inflammation
 P – polyuria (excessive urination)
▪ polypharmacy (5 or more medicines/day
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3
Q

Assessments urinary incontinenceve

A

 Perineal skin: signs of erosion or rashes from urine
 Medications
 Pelvic organ prolapse (POP)
 Strength of Pelvic Floor muscles
 Bladder diary for 2-3 days
▪ timing, volume, leaking, nocturia
 Urine analysis – UTI, Diabetes
 Flow tests – post void residual (PVR)
 Urodynamics when indicated – SI, OAB, obstruction
 Ultra sound - upper urinary tract involvement
▪ Kidney, ureters, bladder and prostate

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4
Q

Urinary Incontinence

Types

A
 Functional incontinence
 Stress incontinence
 Urge incontinence
 Overflow incontinence
 Mixed incontinence
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5
Q

Urinary Incontinence

Treatment

A

 Behavioural therapy
 Pharmacology therapy
 Neuromodulation
 Surgical therapy

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6
Q

Functional Incontinence

A
 Cognitive: dementia
 Functional: mobility
 Environmental factors
 Balance and mobility
 Normal functioning bladder
 Unable to access toilet
 Episodes of urinary incontinence
 Modify environment and care plan
 Facilitate regular, easy access to the toilet
 Normal functioning bladder
 Unable to access toilet
 Episodes of urinary incontinence
 Modify environment and care plan
 Facilitate regular, easy access to the toilet
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7
Q

Interventions urinary incontinence

A
Safety: 
better lighting
removal of scatter rugs
clothing alterations 
Timed voiding, mobility or toilet equipment
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8
Q

Hospitalised Patients

 Prevent incontinence:

A
▪ Answer call bells quickly
▪ Frequent toilet rounds 
▪ Assist to toilet or bed pans
▪ Perineal care after bedpans
▪ Encourage fluids
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9
Q

Stress Incontinence

A

 Sudden increase of intra-abdominal pressure
 Causes involuntary passage of urine
 Coughing, laughing or sneezing
 Physical activities - heavy lifting and exercising
 Leakage in small amounts, may not be daily

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10
Q

Causes of Stress Incontinence

A
 Women with relaxed PF 
muscles from childbirth
 Urethra atrophy -
oestrogen decreases in 
women as they age
 Prostate surgery for BPH or 
prostate cancer
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11
Q

Treatments stress incontinence

A

Pelvic Floor exercises – Kegel exercises
Lifestyle Changes - weight loss if obese
Urethral inserts, patches, oestrogen cream
Pseudoephedrine (Sudafed) – urinary retention
Pessaries and bladder neck support prosthesis for prolapses
External condom catheters, penile clamps
Absorbent products – reusable/disposable pads/underwear

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12
Q

Surgery for Stress Incontinence

A

Artificial Urinary Sphincter
Bulking Agent
Urethral Sling Women
Urethral Sling Men

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13
Q

Urge Incontinence

A

 Urinary urgency followed by involuntary urination
 Occurs randomly
 Over active bladder symptoms: urgency and frequency
 Frequent periodic leaking in lager amounts
 Nocturnal frequency and incontinence are common

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14
Q

Causes of urge incontinence

A

 Uncontrolled contraction or overactivity of detrusor
muscle
 CNS disorders: Alzheimer’s, Parkinson’s disease, MS
 Bladder disorders: cancer, radiation effects or interstitial
cystitis
 Bladder outlet obstruction e.g. enlarged prostat

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15
Q

Behavioural Interventions

urge incontinence

A
 Bladder Retraining 
 Timed voiding 2 - 3hrly
 Prompted voiding: carer
 Urge control strategies
▪ Relaxation/distraction
 Psychologist
 Fluid management
 Decrease dietary irritants:
▪ caffeine, citrus juices
 Keep bowels regular:
▪ fibre, fluids and aperients
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16
Q

Pharmacological Therapies urge incontinence

A
Anticholinergic 
Agents:
oxybutynin 
(Ditropan), 
solifenacin 
(Vesicare)
Beta 3-adrenoceptor 
agonist
Mirabegron 
(Betmiga)
Calcium-channel 
blockers:
amlodipine 
(Norvasc), 
verapamil, 
Cardizem 
Tricyclic 
antidepressants:
Endep