Prolapse & incontinence Flashcards
Causes of incontinence include…
DIAPPEERSS
- D = Delerium
- I = Infection
- A = Atrophic urethritis
- P = Pharmacological (e.g. diuretics)
- P = Psychological (e.g. acute distress)
- E = Endocrine (e.g. hypercalcemia)
- E = Environments (e.g. unfamiliar surroundings)
- S = Stool impaction
- S = Sphincter damage or weakness
List 5 important incontinence history questions
- Do you ever need to pass urine in a hurry, not make it to the toilet or have an accident?
- Do you need to get up at night to go the toilet?
- Do you wear continence pads?
- Do you have urinary frequency, burning when passing in urine or noticed blood in the urine?
- Do you leak when you cough/jump/run?
List the 4 types of incontinence
- True incontinence (usually due to urinary fistula)
- Overflow incontinence
- Urinary stress incontinence
- Urinary urge incontinence
What is the most common type of incontinence
Stress incontinence
(But it can present in a mixed pattern)
What causes stress incontinence
Hypermobile urethra → result of child birth, more rarely urinary sphincter mechanism defects.
Urge incontinence causes include…
Secondary to poor bladder habits
Detrusor overactivity (bladder contracts and empties at low urine volumes with no conscious control).
What further investigations should be conducted if incontinence is suspected
Mid-stream urine C&S to exclude infection
Urodynamic studies
How do you manage stress incontinence?
- Weak pelvic floor – exercises
- Obesity – weight reduction
- Menopause – HRT/vaginal oestrogen creams
- Chronic cough – physiotherapy
- Surgery – suburethral tape procedure
How do you manage urge incontinence
Neurological signs – refer to neurologist
Abnormal voiding patter – bladder retraining
Detrusor overactivity – anticholinergic drugs, intravesical botox for resistant cases
