Week 2 Bowel and Bladder Issues Flashcards
TF: people like to talk about B and B patients
false they don’t
how many times do you void a day, and when do you get the urge to pee? and what is the amount of urine
5-8x/day when the bladder is 2/3 full, and you get 300-400ml urine. and you have 15 drops to the bladder per min to fill it up
what are some age related bladder problems with females
changes to support structures and pelvis organs from vaginal delivery
decreased estrogen causes changes in lower urinary tract
decreased arterial flow to the vagina, thinning, and skin breakdown and less tissue support around the bladder neck. and decreased arterial blood flow and decreased urethral closure pressure
what about age related changes to males
prostate enlarges and growth of prostate tissue encroaches on urethra
what about changes in both sexes
- decreased bladder sensation
- decreased detrusor contraction strength (decreased urine flow rate)
- increase in post urine RV
- decreased diuretic hormone vasopressin, so nocturia.
- loss of renal mass and functional glomeruli and a decrease in renal blood flow and filtration rate
what is urinary incontinence
involuntary leakage of urine
what does continence require
neural coordination between the bladder, urethra and pelvic floor muscles
what are the 5 types of incontinence
stress, urge, overflow, functional, mixed
what two types of incontinence lead to more falls
stress and urge
what is stress incontinence
occurs with effort or exertion like coughing laughing, sneezing, lifting and valsalva
what are some causes of stress UI
childbirth changes in muscles and connective tissue estrogen loss radical prostatectomy caucasian family history obesity smoking chronic cough and respiratory diseases pelvic surgery constipation and neurologic disorders
what is urge UI
strong desire to pass urine which is difficult to defer without involuntary leakage, so like when you don’t make it in time
what causes urge UI
low bladder compliance detrusor over activity bladder contractions (neurologic or pelvic organ prolapse) benign or malignant prostate aging smoking hysterectomy arthritis impaired mobility
why can arthritis and impaired mobility lead to urge UI
because you can’t get there in time
what is overflow UI
bladder overly distended causing bladder pressure to increase, and increasing urethral pressure.
or you lose the sphincter after surgery or injury
what is functional UI
have normal Bowel and urethral function, but have difficulty getting to the toilet before urination occurs like with impaired mobility or cognitive issues.
what is mixed UI
a combo of types
what is the acronym for reversible causes of UI
DIAPPERS
- delirium/altered mental status
- infection, UTI
- atrophic urethritis or vaginitis
- pharma
- pscychological disorders (depression)
- endocrine disorders (hyperglycemia and hypercalcemia)
- restriction in mobility
- stool impaction
what kinds of questions do we ask when we are screening
do you leak with coughing, laughing…
do you leak on way to bathroom
do you have to strain to empty bladder
do you feel you cannot completely void
red flag UI questions?
- sudden onset incontinence
- leaking occur post surgery or with medication change
- burning blood?
- change in vaginal discharge, odor?
- difficulty initiating stream
- large amounts incontinence without warning?
what kinds of meds cause reduces urethral pressure
anti-hypertensives
neuroleptics
benzodiazepines
what meds impact full bladder emptying
anticholinergics
beta blockers
what is the caution with reducing fluids
ask about how much they take in. you do not want to limit to cause more constipation, or to cause dehydration or UTI
UITs in the aging adult
usually silent became no fever, and increased urge is viewed as normal aging
what are S/S or UTI
unilateral costovertebral tenderness flank pain ipsilateral shoulder pain fever and chills skin hypersensitivity hematuria pyuria (pus in urine) bacteriuria nocturia
what do PT interventions for incontinence focus on
PFM exercises, quick contractions, sustained, and contractions during functional activities
can we use biofeedback for incontinence
yes, surface EMG and palpation
is there a lot of evidence about E-STIM
no
what is a great exercise for incontinence. what is the caution
kegels, “stop urination mid stream” but do not do this often for you might get a UTI
what is bladder training and what is it used for and what is the goal
urge UI. gradual increase in time intervals between voids. use distractions, breathing and PFM contractions to inhibit bladder contractions. goal is to delay voiding to 3-4 hours
what are lifestyle changes you can make for UI
weight loss
reduce caffeine and medications
what is bowel incontinence
involuntary loss of stolen through the anus severe enough to cause hygienic and social problems
what can cause bowel incontinence
age related loss in strength, changes in elasticity decreased anal tone loss anal sensation fecal impaction loss continence mechanism (pudendal nerve, neurologic control, anorectal trauma) behavioral and psychological (depression and dementia) neoplasms
how do we intervene with bowel incontinence
specialists dietary increase fiber and fluid toileting schedule neuromuscular re-ed and biofeedback PFM exercises
