Week 2 Bowel and Bladder Issues

Question 1

TF: people like to talk about B and B patients

Answer 1

false they don’t

Question 2

how many times do you void a day, and when do you get the urge to pee? and what is the amount of urine

Answer 2

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

Question 3

what are some age related bladder problems with females

Answer 3

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

Question 4

what about age related changes to males

Answer 4

prostate enlarges and growth of prostate tissue encroaches on urethra

Question 5

what about changes in both sexes

Answer 5

• 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

Question 6

what is urinary incontinence

Answer 6

involuntary leakage of urine

Question 7

what does continence require

Answer 7

neural coordination between the bladder, urethra and pelvic floor muscles

Question 8

what are the 5 types of incontinence

Answer 8

stress, urge, overflow, functional, mixed

Question 9

what two types of incontinence lead to more falls

Answer 9

stress and urge

Question 10

what is stress incontinence

Answer 10

occurs with effort or exertion like coughing laughing, sneezing, lifting and valsalva

Question 11

what are some causes of stress UI

Answer 11

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

Question 12

what is urge UI

Answer 12

strong desire to pass urine which is difficult to defer without involuntary leakage, so like when you don’t make it in time

Question 13

what causes urge UI

Answer 13

low bladder compliance 
detrusor over activity 
bladder contractions (neurologic or pelvic organ prolapse)
benign or malignant prostate 
aging 
smoking 
hysterectomy 
arthritis 
impaired mobility

Question 14

why can arthritis and impaired mobility lead to urge UI

Answer 14

because you can’t get there in time

Question 15

what is overflow UI

Answer 15

bladder overly distended causing bladder pressure to increase, and increasing urethral pressure.
or you lose the sphincter after surgery or injury

Question 16

what is functional UI

Answer 16

have normal Bowel and urethral function, but have difficulty getting to the toilet before urination occurs like with impaired mobility or cognitive issues.

Question 17

what is mixed UI

Answer 17

a combo of types

Question 18

what is the acronym for reversible causes of UI

Answer 18

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

Question 19

what kinds of questions do we ask when we are screening

Answer 19

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

Question 20

red flag UI questions?

Answer 20

• 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?

Question 21

what kinds of meds cause reduces urethral pressure

Answer 21

anti-hypertensives
neuroleptics
benzodiazepines

Question 22

what meds impact full bladder emptying

Answer 22

anticholinergics

beta blockers

Question 23

what is the caution with reducing fluids

Answer 23

ask about how much they take in. you do not want to limit to cause more constipation, or to cause dehydration or UTI

Question 24

UITs in the aging adult

Answer 24

usually silent became no fever, and increased urge is viewed as normal aging

Question 25

what are S/S or UTI

Answer 25

unilateral costovertebral tenderness
flank pain 
ipsilateral shoulder pain 
fever and chills 
skin hypersensitivity 
hematuria 
pyuria (pus in urine)
bacteriuria 
nocturia

Question 26

what do PT interventions for incontinence focus on

Answer 26

PFM exercises, quick contractions, sustained, and contractions during functional activities

Question 27

can we use biofeedback for incontinence

Answer 27

yes, surface EMG and palpation

Question 28

is there a lot of evidence about E-STIM

Answer 28

no

Question 29

what is a great exercise for incontinence. what is the caution

Answer 29

kegels, “stop urination mid stream” but do not do this often for you might get a UTI

Question 30

what is bladder training and what is it used for and what is the goal

Answer 30

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

Question 31

what are lifestyle changes you can make for UI

Answer 31

weight loss

reduce caffeine and medications

Question 32

what is bowel incontinence

Answer 32

involuntary loss of stolen through the anus severe enough to cause hygienic and social problems

Question 33

what can cause bowel incontinence

Answer 33

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

Question 34

how do we intervene with bowel incontinence

Answer 34

specialists 
dietary increase fiber and fluid 
toileting schedule 
neuromuscular re-ed and biofeedback 
PFM exercises