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Geriatrics > Continence > Flashcards

Continence Flashcards

1
Q

In what populations is incontinence most likely?

A

Three times more likely to affect females than males

Two peaks in age- post-menopause and elderly

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2
Q

What is the goal of management of incontinence?

A

Identify cause of incontinence and treat it

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3
Q

What are the two broad categories of causes of incontinence?

A

Extrinsic- environmental, habit and physical fitness
Intrinsic- problem with the urinary system
Often both present

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4
Q

What are some extrinsic causes of incontinence?

A
  • Physical state and co-morbidities
  • Reduced mobility
  • Confusion
  • Drinking too much or at the wrong time
  • Medications
  • Constipation
  • Home circumstances
  • Social circumstances
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5
Q

What are the intrinsic causes of incontinence?

A

Intrinsic factors contributing to incontinence can be to do with the bladder or the outlet being too weak or too strong

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6
Q

When does stress incontinence occur?

A

When the bladder outlet is too weak

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7
Q

What are the characteristics of stress incontinence?

A
  • Urine leak on movement, coughing, laughing, squatting, etc.
  • Weak pelvic floor muscles
  • Common in women with children, especially after menopause
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8
Q

How is stress incontinence treated?

A

Treatments of stress incontinence include physiotherapy, oestrogen cream and duloxetine. Surgical treatment is also possible with TVT/colposuspension.

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9
Q

When does urinary retention with overflow incontinence occur?

A

When the bladder outlet is too strong

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10
Q

What are the characteristics of urinary retention with overflow incontinence?

A
  • Poor urine flow, double voiding,
  • Hesitancy, post micturition dribbling
  • Blockage to urethra
  • Older men with BPH
  • Only type of incontinence more common in males
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11
Q

How is urinary retention with overflow incontinence treated?

A

Treatment can be done with alpha blockers, anti-androgens or surgical TURP.
Catheterisation may be required, often done suprapubically.

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12
Q

When does urge incontinence occur?

A

When the bladder muscles are too strong

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13
Q

What are the characteristics of urge incontinence?

A
  • 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
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14
Q

How is urge incontinence treated?

A

Treatment can be done with anti-muscarinics, to relax the detrusor, with bladder retraining sometimes being necessary.

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15
Q

How is bladder retraining done?

A

Bladder retraining involves getting the patient to void every 90-120mins, regardless of urge to void.

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16
Q

When does a neuropathic bladder occur?

A

When the bladder muscle is underactive

17
Q

What are the characteristics of a neuropathic bladder?

A
  • 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
18
Q

How is the neuropathic bladder treated?

A

Medical treatments are usually unsatisfactory but parasympathomimetics may help
Catheterisation is the only effective treatment

19
Q

What type of incontinence occurs when the bladder muscle is overactive?

A

Urge incontinence

20
Q

What type of incontinence occurs when the bladder muscle is under active?

A

Neuropathic bladder

21
Q

What type of incontinence occurs when the bladder outlet is too weak?

A

Stress incontinence

22
Q

What type of incontinence occurs when the bladder outlet is too strong?

A

Urinary retention with overflow incontinence

23
Q

What are some examples of anti-muscarinic drugs?

A

Oxybutinin
Tolterodine
Solifenacin
Trospium

24
Q

What affect do anti-muscarinics have in incontinence?

A

Relaxes the detrusor

25
Q

What is an example of a β3-adrenoreceptor?

A

Mirabergon

26
Q

What affect do β3-adrenoreceptors have in incontinence?

A

Relaxes the detrusor

27
Q

What are some examples of α-blockers?

A

Tamsulosin
Terazosin
Indoramin

28
Q

What affects do α-blockers have in incontinence?

A

Relaxes sphincter and bladder neck

29
Q

What are some examples of anti-androgen drugs?

A

Finasteride

Dutasteride

30
Q

What are the affects of anti-androgen drugs in incontinence?

A

Shrinks the prostate

31
Q

What steps should be included in assessment of incontinence?

A
  • Careful history with emphasis on social history to assess impact of incontinence and identify extrinsic factors
  • Intake chart and urine output diaries
  • General examination plus vaginal and rectal examinations
  • Urinalysis and MSSU
  • Bladder scan to assess residual volume
  • Consider referral to incontinence clinic in difficult cases
  • Suggest lifestyle/medication changes
  • Consider physiotherapy, medical or surgery therapies
32
Q

When should patients be referred to an incontinence specialist?

A

In cases of persistent urinary incontinence, patients should be referred to a specialist after failure of initial management- maximum three months of pelvic floor exercises, cone therapy, habit retraining and/or appropriate medication

33
Q

What patients should be referred to an incontinence specialist when presenting?

A

Patients with the following:

  • Vesico-vaginal fistula
  • Palpable bladder after micturition or confirmed large residual volume of urine after micturition
  • Disease of the CNS
  • Certain gynaecological conditions (e.g. fibroids, procidentia, rectocele, cystocele)
  • Severe benign prostatic hypertrophy or prostatic carcinoma
  • Patients who have had previous surgery for continence problems
  • Others in whom a diagnosis has not been made
34
Q

When should referral to a specialist be done in cases of faecal incontinence?

A

Indications for specialist referral in faecal incontinence are:
Failure of initial management
Suspected sphincter damage
Neurological disease

35
Q

What options are available when management of incontinence fails?

A
  • Incontinence pads
  • Urosheaths
  • Intermittent catheterisation
  • Long term urinary catheter
  • Suprapubic catheter

Geriatrics (6 decks)

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