Continence (Part 2) Flashcards by Chelsea Barker

What does assessment of continence include?

Clinical history (nature of problem, duration/severity of symptoms)
Medical and surgical history
Exacerbating factors
Functional and mental status
Impact of symptoms on QOL

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Which HPs are in the management team for incontinence?

G.P.
Geriatrician, Urologist, Urogynaecologist
Continence nurse
Physiotherapist
Occupational therapist
Social worker
Dietician

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What are the barriers to seeking help for incontinence?

Embarrassment
Social stigma
Inevitable, untreatable, normal part of ageing
Language, level of education and cultural factors
Lack of bathroom privacy
Inadequate identification & assessment by HPs

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What are general management options for incontinence?

Empathy (supportive role of staff)
Improving environment (appropriate chair, rails in toilets, adequate lighting)
Promotion of good bladder habits

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What are the 4 steps of good bladder habits?

Fluid intake
Good bowel habits
PF muscle exercises
Good toilet habits

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What are the guidelines for fluid intake?

1.5-2L per day
Limit caffeine & alcohol
Output 1-1.5L per day

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What are good bowel habits?

Avoid constipation
Don’t ‘strain at stool’
Positions for defecation

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How can PF exercises be made functional?

Ok to teach in lying but most don’t leak when in bed
Task orientated & functional
Specific to patient’s problem
Involved in ADLs
May need triggers as reminders

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What are good toilet habits?

No “just in case” toileting

- Taking time to completely empty bladder

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Why should “just in case” toileting be avoided?

Increased frequency&raquo_space; reduced stretching of bladder&raquo_space; decreased capacity&raquo_space; increased frequency

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What are the aims of bladder training?

Decrease frequency
Increase urine quantity
Defer urge
Improve lifestyle

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What does bladder training include?

Practise PFM exercises
Defer the urge
Start at home
Keep a bladder diary
Seek help re medication

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What should be avoided during bladder training?

Decrease fluid intake
Just in case toilet
Wear pads
Drink caffeine and alcohol
Get stressed

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What are the deferment strategies?

Contract PF muscles
Apply pressure to perineum (hold on, drop hip, corner of chair, roll towel, crossed thighs)
Distract mind/relax

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How should deferment strategies be implemented?

Initially defer for 5 mins
Gradually increase time
Do not empty without urge

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What are the physio interventions for incontinence?

PF muscle exercises
LL strength training
Upper limb function (buttons, zips)
Appropriate aids

What are the continence strategies for RAC?

Mobility
Prompted voiding
Regular toileting
Use of continence service

What is the aim of pharmacology in managing incontinence?

Increase bladder emptying & storage

- Increase/decrease outlet resistance

What is anal incontinence?

Involuntary loss of flatus, (liquid or solid) stool that is a social or hygienic problem
Can occur as a result of: 
- constipation
- neurological damage
- loss of sphincter control or 
- laxative abuse

What are the risk factors for constipation?

Polypharmacy
Anticholinergic drugs
Opiates
Iron supplements
Calcium channel antagonists
NSAIDs
Immobility
Institutionalisation
PD
Diabetes mellitus
Low fluid intake
Low dietary fibre
Dementia
Depression

What co-morbidities are related to faecal incontinence?

Dementia
CVA
Diabetes mellitus with neuropathy
Sacral cord dysfunction

What are the causes of FI?

Functional FI
Anorectal incontinence: IAS, EAS dysfunction, prolapse
Loose stools / diarrhoea
Excessive laxative use
Rectal/colonic disease

What are the causes of diarrhoea?

Stimulant laxatives
Bowel/stomach infection
Bowel disease
Drug interactions
Shortened bowel
Food intolerance
Radiotherapy
Alcohol

What does diarrhoea management include?

GP/specialist review may be necessary
?avoid insoluble fibres
?increase intake of soluble fibres
?increase fluid intake
?drug therapy
Reduce alcohol, caffeine & smoking

What does management of constipation include?

- Firstly relieve the constipation, then revise the management - Dietary: Fibre intake - Fluids: 1.5-2 L non-irritative drinks - Laxatives/Aperients - Activity/Exercise - Aids and appliances - Environment (accessibility of toilet)

What are the signs & symptoms of urinary tract infections?

Signs: - Increased body temperature - +ve urine microbial culture with large number of pus cells - Voiding dysfunction Symptoms: - Confusion, febrile, smelly urine - Frequency/urgency - Stinging

What is the treatment for UTI?

- Antibiotics - Decrease pelvic floor & anterior urethral colonisation - Personal hygiene (washing perineum, underwear etc)

What are the principles of catheter use?

- Relieve and manage urinary dysfunction - Recognise & minimize risks of secondary complications - Promote dignity and comfort - Assist clients to reach self care & independence

What are the types of catheters?

- Suprapubic catheter (SPC) - Indwelling catheter (IDC) - Intermittent self catheterization (CISC or ISC)

What are the precautions for catheter use?

- Ensure urine is always allowed to flow freely - No kinks in the tubing - Urine bag must be kept below the level of the bladder - Catheter secured with a leg strap to prevent being pulled out

What is the function of the PF?

- Pelvic organ support - Additional occlusive force to external urethral sphincter - Maintain anorectal angle - Rectal support during defecation - Bladder inhibition - Sexual function

What factors contribute to PF dysfunction?

- Type of connective tissue - Pregnancy, labour, delivery - Menopause, ageing - Medication - Lifestyle - Stretching of support structures - Perineal trauma - Urinary retention - Postnatal care of perineum

What is pelvic organ prolapse (POP)?

Descent of pelvic organs towards the introitus | associated with vaginal wall & pelvic ligament weakness

What are the causes of POP?

- Stretched pelvic fascia & ligaments following very fast or very long 2nd stages - Many large babies - Patients with “cervix on view” at delivery are at higher risk of future prolapse - Constipation and chronic cough - Heavy lifting - Chronic LBP with weak TA

What is the treatment for prolapse?

- Strengthen lower abs & PF - Address constipation and respiratory disease - Modify lifestyle These measures will not cure vaginal wall prolapse but may prevent further descent and will give surgery a better long-term outcome

What is chronic pelvic pain?

- Chronic or recurrent pelvic pain that apparently has a gynaecological origin but for which no definitive or cause is found - Perceived in structures related to the pelvis - Pain associated with symptoms of LUT, sexual, bowel or gynaecological dysfunction

What should the assessment of PFM include?

- Visual inspection - Observation - Sensation and neural - Palpation external/internal - PFM contractile activity - Spasm - Relaxation

What is the pain behaviour chronic pelvic pain?

- May have mechanical component - Aggravated by stress - Not necessarily associated with spinal dysfunction - If spinal dysfunction present, may interact with myofascial dysfunction - Visceral symptoms may be present (diarrhoea, constipation, period pain)

What are the treatments for chronic pelvic pain & PF dysfunction?

- Lifestyle interventions - Exercises - Down training - Manual therapy (Myofacial and trigger points) - Biofeedback and electrical stims - Dilators