Continence Flashcards
(35 cards)
In what populations is incontinence most likely?
Three times more likely to affect females than males
Two peaks in age- post-menopause and elderly
What is the goal of management of incontinence?
Identify cause of incontinence and treat it
What are the two broad categories of causes of incontinence?
Extrinsic- environmental, habit and physical fitness
Intrinsic- problem with the urinary system
Often both present
What are some extrinsic causes of incontinence?
- Physical state and co-morbidities
- Reduced mobility
- Confusion
- Drinking too much or at the wrong time
- Medications
- Constipation
- Home circumstances
- Social circumstances
What are the intrinsic causes of incontinence?
Intrinsic factors contributing to incontinence can be to do with the bladder or the outlet being too weak or too strong
When does stress incontinence occur?
When the bladder outlet is too weak
What are the characteristics of stress incontinence?
- Urine leak on movement, coughing, laughing, squatting, etc.
- Weak pelvic floor muscles
- Common in women with children, especially after menopause
How is stress incontinence treated?
Treatments of stress incontinence include physiotherapy, oestrogen cream and duloxetine. Surgical treatment is also possible with TVT/colposuspension.
When does urinary retention with overflow incontinence occur?
When the bladder outlet is too strong
What are the characteristics of urinary retention with overflow incontinence?
- Poor urine flow, double voiding,
- Hesitancy, post micturition dribbling
- Blockage to urethra
- Older men with BPH
- Only type of incontinence more common in males
How is urinary retention with overflow incontinence treated?
Treatment can be done with alpha blockers, anti-androgens or surgical TURP.
Catheterisation may be required, often done suprapubically.
When does urge incontinence occur?
When the bladder muscles are too strong
What are the characteristics of urge incontinence?
- Detrusor contracts at low volumes
- Sudden urge to pass urine immediately
- Patients often know every public toilet
- Can be caused by bladder stones or stroke
How is urge incontinence treated?
Treatment can be done with anti-muscarinics, to relax the detrusor, with bladder retraining sometimes being necessary.
How is bladder retraining done?
Bladder retraining involves getting the patient to void every 90-120mins, regardless of urge to void.
When does a neuropathic bladder occur?
When the bladder muscle is underactive
What are the characteristics of a neuropathic bladder?
- Rare
- Secondary to neurological disease, typically multiple sclerosis or stroke
- Can also be secondary to prolonged cathetarisation
- No awareness of bladder filling resulting in overflow incontinence
How is the neuropathic bladder treated?
Medical treatments are usually unsatisfactory but parasympathomimetics may help
Catheterisation is the only effective treatment
What type of incontinence occurs when the bladder muscle is overactive?
Urge incontinence
What type of incontinence occurs when the bladder muscle is under active?
Neuropathic bladder
What type of incontinence occurs when the bladder outlet is too weak?
Stress incontinence
What type of incontinence occurs when the bladder outlet is too strong?
Urinary retention with overflow incontinence
What are some examples of anti-muscarinic drugs?
Oxybutinin
Tolterodine
Solifenacin
Trospium
What affect do anti-muscarinics have in incontinence?
Relaxes the detrusor
