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Geriatrics > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

Risks that come alongside urinary incontinence?

A

Increase risk of falls and fractures
Social isolation and toilet mapping
Skin irritation and pressure sores
Increased risk of catheterization

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2
Q

How does the bladder act to store urine and how much is stored?

A

can store maximum of 500mls but usually empty at 250mls

Smooth muscle detrusor muscle allows expansion of bladder without increased pressure

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3
Q

What is the urethra made from?

A

Fibromuscular tube lined with mucosa

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4
Q

Where can the urethral opening and internal ureteral orifice be found?

A

Trigone

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5
Q

What are the 3 layers of muscle that surround the proximal urethra as it leaves the bladder?

A

Outer striated
Middle circular smoother muscle
Inner longitudinal smooth muscle

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6
Q

What is the outer striated muscle layer of the urethra also known as?

A

Rhabdosphincter

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7
Q

What is the difference between the internal and the external sphincters of the urethra?

A

Internal sphincter is detrusor continuation that extends nearly the whole length of the urethra
External sphincter has an intramural and extramural component that extends into the pelvic floor muscles

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8
Q

What 2 areas of the brain delay voiding by inhibiting the pontine micturition centre?

A

Hypothalamus and prefrontal cortex

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9
Q

Where is the pontine micturition centre found?

A

Brainstem

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10
Q

Motor innervation is sent via pudendal nerve which is involved in continenece?

A

Innervation to levator ani muscle

Contraction of external urethral sphincter

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11
Q

What nerve provides sympathetic innervation to the bladder and urethra? What nerve roots does this come from?

A

Hypogastric nerve from T10-L2

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12
Q

What kind of innervation does the hypogastric nerve provide and what does it cause?

A

Sympathetic innervation
Provides SM contraction of the urethra and bladder base
Detrusor muscle relaxation

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13
Q

What receptors on the detrusor muscle are activated by sympathetic innervation causing relaxation?

A

Beta 3

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14
Q

What spinal roots does parasympathetic innervation of ht bladder come from? What receptors are stimulated? Where? what happens?

A

S2-S4
Stimulates M3 muscarinic receptors on detrusor
Causes detrusor contraction

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15
Q

Where is the spinal micturition centre?

A

S2-S4 = effectively the parasympathetic supply

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16
Q

How does the bladder change as we age?

A

Less contractility - leaves greater residual volume
Less capacity
Detrusor overactivity
Bacteraemia more common
Increased volume excreted later in the day or at night

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17
Q

How do the pelvic floor muscles change as we age?

A

Pelvic floor muscle atrophy

Pelvic organ prolapse especially when they can’t compensate for changes in intra-abdominal pressure

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18
Q

Difference in urinary leakage types caused by atrophic vaginitis vs prostate enlargement?

A

Atrophic vaginitis = incontinence

enlarged prostate = overflow

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19
Q

Two classifications of duration in terms of urinary incontinence?

A

Transient

Established

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20
Q

DIAPPERS pneumonic for transient incontinence?

A 
Delirium
Infection
Atrophic urethritis/vaginitis
Pharmacological
Psychological
Excessive UO
Reduced mobility
Stool impaction
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21
Q

6 different types of incontinence?

A 
Urge incontinence
Stress incontinence
Mixed incontinence
Overflow incontinence
Neurological or reflex incontinence
Functional incontinence
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22
Q

What is the usual demographic for individuals suffering stress incontinence?

A

Female

After surgery or childbirth

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23
Q

Pathophysiology of stress incontinence?

A

Weakened external sphincter and prolapse bladder neck
Causes no prevention to the stop of urine when there is an increase in intraabdominal pressure - coughing, standing, exercise, obesity

24
Q

What is the non-pharmacological management of stress incontinence?

A

Lose weight
Pelvic floor exercises
Treat any chronic cough

25
Q

What is the pharmacological management of stress incontinence?

A

Duloxetine

Topical oestrogen

26
Q

What is the surgical management of stress incontinence?

A

TVT - tension free vaginal tape

27
Q

What causes urge incontinence?

A

Impaired inhibition of contraction

28
Q

What is the difference between detrusor hyperreflexia and detrusor instability?

A

Hyperreflexia is urge incontinence caused by an neuro lesion like dementia or a CV event
Instability is caused by irritants like UTI, malignancy, caffeine or obstruction

29
Q

How are the signs and symptoms of Urge incontinence grouped into 2 cateogries?

A

OAB wet

OAB dry

30
Q

2 subcategories of detrusor overactivity?

A

Normal contractility

Impaired contractility with over 100ml residual

31
Q

What is non-pharmacological management of OAB?

A

Bladder retraining

32
Q

When is pharmacological intervention considered with OAB?

A

After 6-8 weeks of failed bladder retraining

33
Q

What 3 pharmacological interventions are considered as treatment for OAB?

A

Oxybutynin - antagonise parasympathetic innervation (S2-S4)
Mirabegron - antagonises B3 receptors
Desmopressin - Risk of hyponatraemia

34
Q

What surgical intervention is considered for OAB?

A

Botulinum injection

35
Q

6 typical patients who get reflex/neurological incontinence?

A 
MS
Parkinsons
Dementia
Brain tumour
Spinal cord injury
Stroke
36
Q

What are the signs of neuro/reflex incontinence?

A

Patients have no awareness that they need to micturate

Patients spontaneously lose control of their bladder

37
Q

How do you manage a person with reflex/neurological incontinence?

A

Intermittent catheterization for 2 weeks then trial of void, again after 4 weeks and trial
Long term catheter may be only solution

38
Q

Who is the typical patient with overflow incontinence?

A

Men
Prostate enlargement
History of catheter use
Local malignancy

39
Q

What are the typical symptoms of someone suffering with overflow incontinence?

A

Difficulty initiating - hesitancy
Poor stream
Post void dribble
Nocturia

40
Q

2 medical interventions for overflow incontinence?

A

Alpha antagonists to relax sphincters

5 alpha reductase inhibitors

41
Q

Surgical interventions for overflow incontinence?

A

Transurethral dilatation
TURP
Long term catheter

42
Q

What causes functional incontinence?

A 
External to the bladder:
Poor mobility
Poor dexterity
Poor cognition
Dementia
43
Q

What 2 teams should functional incontinence be referred to?

A

Physio

OT

44
Q

How do physio and OT usually help in functional incontinence?

A

Mobility aids
Exercises
Home adaptations

45
Q

What is the most common form of incontinence that presents as a clinical picture?

A

Mixed incontinence - stress and urge

46
Q

How do you determine predominant cause of mixed incontinence?

A

Urodynamics

47
Q

History questions in incontinence assessment?

A 
Onset
Precipitating factors
Frequency
Volume
Dysuria!!!!
Straining
Poor stream
Incomplete emptying
Daily pattern of voiding
48
Q

6 conditions in an individuals past medical history do you need to ask about for UI?

A

Diabetes mellitus?
Hypercalcaemia?
Neuro symptoms? - parkinsons, dementia, stroke
CCF?
Peripheral venous insufficiency?
Any previous surgery pelvic/lower abdomen?

49
Q

5 drugs to as about in an incontinence history?

A 
diuretics
caffeine
alcohol
NSAIDs
Calcium antagonists
50
Q

In a neuro exam of someone presenting with urinary incontinence where is it particularly important to examine?

A

Perianal sensation and anal tone

51
Q

During a rectal exam of someone presenting with incontinence what 2 things are you looking for?

A

Fecal impaction

Prostate enlargement

52
Q

What can you do to investigate urinary incontinence?

A 
Intake/void diary
Urinalysis
B12/folate/FBC
U&E (calcium)
Glucose
MSSU
PSA
Post void residual volume
Urodynamics - diagnosis unclear
53
Q

What are some different types of urodynamic methods that can be used?

A

Cystometogram - evaluate filling not voiding with concurrent measure of abdominal pressure, requires urethral catheter and rectal transducer
Uroflowmetry - pee into electric dish
Urethral profilometry
Fluoroscopy - radioopaque
Videodynamics or ambulatory urodynamics - if diagnosis unclear

54
Q

What are 4 indications for short term catheter use?

A

After surgery to pelvis
When it would be too difficult to move - fractured neck of femur
Urinary retention
When monitoring is critical - ie critically ill

55
Q

5 reasons for long term catheter use?

A 
Neurogenic bowel with urinary retention
Skin breakdown due to incontinence
Palliative care
Patient preference
Obstruction of bladder outlet
56
Q

4 complications of long term catheter use?

A

UTI - bacteraemia, urosepsis
Chronic renal inflammation
Pyelonephritis
Nephrolithiasis

Geriatrics (10 decks)

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