Aging - Urinary Incontinence and Constipation Flashcards
(12 cards)
What is the DDx for transient incontinence (TOILETED)?
T - Thin, dry vaginal/urethral epithelium ex. vaginitis, urethritis
O - Obstruction ex. stool impaction
I - Infection ex. UTIs
L - Limited mobility/functional impairment
E - Emotional disorder esp. depression
T - Therapeutic medications ex. diuretics
E - Excessive urine output/Endocrine disorders
D - Delirium/confusion
An elderly patient presents with complaints of involuntary leakage of urine which is accompanied with a strong need to void. When they void there are large volumes of urine. The patient also complains of having to wake up at night to use the toilet. What type of incontinence is this? Causes?
This is urge incontinence; leakage with urgency, moderate to large volumes of urine, nocturnal frequency, and low PVR. This is due to an overactive detrusor muscle. Causes include: UMN lesion (stroke, PD, AD, cerebral tutor), non neurological problems (bladder stone, carcinoma, bladder outlet obstruction).
What is the treatment for urge incontinence?
Non pharma: planned voiding, bladder training, remove barriers to voiding (mobility), no fluids 3-4 hrs before bed, avoid caffeine and ETOH etc.
Pharma: the first line medication is mirabegron (beta 3 adrenergic agonist)
A 68 yr old woman presents with complaints of small amounts of urine leakage when sneezing, coughing and lifting groceries into her car etc. She does not complain of nocturnal incontinence. What type of incontinence is this? Causes?
This is stress incontinence. Causes include increased urethral mobility, poor intrinsic sphincter function and/or weak pelvic floor muscles. It is more common in women and nocturnal frequency is rare. PVR is low/normal.
What is the treatment for stress incontinence?
Non pharma: Kegel’s, absorbent underwear
Pharma: duloxetine (serotonin and norepi agonist), cymbalta (SNRI), surgery
An older adult presents with complaints of urgency to urinate but then when they get to the toilet they are only able to pass small amounts of urine. They strain to void, have a weak flow of urine and often feel they have not been able to completely empty their bladder. What type of incontinence is this? Causes?
This is overflow incontinence. This is caused by over-distention of the bladder. These patients have leakage of small amounts of urine at night and during the day. They may have a history of hesitancy, straining to void, weak or interrupted flow, sense of incomplete bladder emptying and may have a palpable bladder on exam. Causes include: 1. outlet obstruction (prostate enlargement, urethral stricture, large cystourethrocele, pelvic organ prolapse) 2. underactive detrusor (disc compression, plexopathy, surgical damage, autonomic neuropathy).
What is the treatment for BPH?
5-alpha-reductase inhibitors
What are red flags that should prompt referral of patients with urinary incontinence?
HEMATURIA PALPABLE BLADDER AFTER VOID SUSPECTED PELVIC MASS GROSS ORGAN PROLAPSE Post residual volumes >200ml Recent hx of surgery/radiation to tract/pelvis Recurrent UTIs
What is the treatment for mixed incontinence?
Mixed = stress + urge. Non pharma: scheduled voids, bladder training, fluid schedule, Kegel’s?, oxybutynin.
What are the side effects of anticholinergic medications?
Hot as a hare: increased body temperature
Blind as a bat: mydriasis (dilated pupils)
Dry as a bone: dry mouth, dry eyes, decreased sweat
Red as a beet: flushed face
Mad as a hatter: delirium
In a patient who presents with constipation, what are the red flags?
Red flags:
- Blood in stool
- Iron deficiency anemia
- Weight loss
- Bright red blood per rectum
- FHx of colon cancer
- Change in bowel habits
If a patient presents with constipation and is not impacted what are the pharmacological options?
Osmotic laxatives: lactulose, PEG
Other agents include stimulant laxatives (senokot), bulk forming laxatives (psyllium), suppositories (glycerine), enemas.
