Elderly Continence

Question 1

State the prevalence of incontinence in women

Answer 1

34%

Question 2

State the prevalence of incontinence in older adults

Answer 2

30-50%

Question 3

Incontinence is seen to be a big contributor to

Answer 3

Functional decline

Question 4

Define Urinary Incontinence

Answer 4

Unintentional passing of urine

Question 5

State what bladder control is dependant on

Answer 5

Functioning bladder
Functioning sphincters
Cognition
Mobility
Dexterity
Environment

Question 6

What happens to the bladder in age

Answer 6

Reduced capacity, reduced residual volume, prostate hypertrophy, increased urine production at night, vaginal atrophy

Question 7

State the co-morbidities that can contribute to incontinence

Answer 7

Decreased mobility, bladder outlet obstruction, constipation, stroke, spinal chord pathology, cognitive impairment

Question 8

State the reversible factors that can result in incontinence

Answer 8

UTI, prolapse, delirium, medications, polydypsia

Question 9

State the environmental factors that can contribute to incontinence

Answer 9

Toilet on a different level, mobility, assistance

Question 10

Control of detrusor muscle

Answer 10

Involuntary control

Question 11

Control of internal urethral sphincter

Answer 11

Involuntary which usually opens when bladder is half full

Question 12

Control of external urethral sphincter

Answer 12

Striated muscle therefore voluntary

Question 13

Parasympathetic innervation of the bladder

Answer 13

S2-S4 (Muscarinic receptors) leads to detrusor muscle contractions and promotes urination

Question 14

Sympathetic innervation of the bladder

Answer 14

T10-L2 (B2 adrenoreceptors) detrusor muscle relaxation

T10-S2 (a adrenoreceptors) internal sphincter contraction

Question 15

Motor innervation of urination

Answer 15

S2-S4 external sphincter contraction

Question 16

Describe the process of urinartion (reflex)

Answer 16

Stretch receptors stimulated, spinal chord, parasympathetic nerves stimulated and therefore detrusor muscle contraction

Question 17

Pontine micturition control centre

Answer 17

Blocks the parasympathetic actions and leads to detrusor relaxation so allows the storage of urine

Question 18

Frontal cortex control of urine

Answer 18

Voluntary voiding of urine

Question 19

What is stress incontinence

Answer 19

Urine typically leaks with increased abdominal pressures - coughing, sneezing, laughing, standing up

Question 20

Why does stress incontinence occur

Answer 20

Outlet from the bladder is weak - weak external sphincter and weak pelvic floor muscles

Question 21

When is stress incontinence common

Answer 21

In women who have had children, more so after menopause

Question 22

What is urge incontinence

Answer 22

Associated with the sudden urge to pass urine

Question 23

What is the cause of urge incontinence

Answer 23

Detrusor muscle instability (overactive bladder) and contracts with low urine volumes. Due to UMN lesion or detrusor muscle disorder.

Question 24

State the common presentation of urge incontinence

Answer 24

Frequency and nocturnal incontinence

Question 25

What is overflow incontinence

Answer 25

Urine is retained in the bladder with subsequent overflow

Question 26

What causes overflow incontinence

Answer 26

Bladder outlet obstruction (prostatic hypertrophy or tumour) and constipation

Question 27

State the typical symptoms with overflow incontinence

Answer 27

Hesitancy, reduced stream and post-micturition dribbling

Question 28

State what the patient can do to help identify what type of incontinence they may have

Answer 28

Patient diary over 3 days

Question 29

State the examinations that can be performed on the patient

Answer 29

Determine strength of the pelvic floor muscles, assess for constipation, assess for prolapse

Question 30

State the investigations that can be conducted in incontinence

Answer 30

Urinalysis/MSSU, bladder scan (check residual volume), urodynamics (cystometry, uroflowmetry)

Question 31

State general measures used in the management of incontinence

Answer 31

Weight control, fluid control, reduce bladder irritants (caffeine, fruit juice and alcohol), pelvic floor exercises, bladder retraining, pads/urinals

Question 32

State the first line treatment of stress incontinence

Answer 32

Pelvic floor exercises (kegel exercises)

Question 33

State minimum amount of contractions done a day (minimum)

Answer 33

8 contractions 3 times a day

Question 34

How long will pelvic floor exercises take to have an effect

Answer 34

3 months

Question 35

State aids available for the pelvic floor exercises

Answer 35

Biofeedback (measuring how the muscles are working), vaginal cones, electrical stimulation (when cannot actively contract pelvic floor muscles)

Question 36

State the surgical treatments for stress incontinence

Answer 36

Colposuspension, TVT tape

Question 37

State the first line treatment of urge incontinence

Answer 37

Bladder retraining and pelvic floor exercises

Question 38

State the medications which are used in urge incontinence

Answer 38

Anti-cholinergics (to relax the detrusor muscle). Oxybutynin, tolterodine and solifenacin.

Question 39

State the side effects of anti-cholinergics

Answer 39

Cognitive impairment, dry mouth, constipation, blurred vision, postural hypotension, drowsiness, urinary retention

Question 40

State the other treatments for urge incontinence

Answer 40

Botulinum toxin (to relax detrusor muscle) and sacral nerve stimulation

Question 41

State the management of overflow incontinence

Answer 41

Relieve the obstruction - prostatic hypertrophy/tumour (anti-androgen, finasteride) Relax the sphincter - prostatic hypertrophy (alpha blocker) By-pass the obstruction - catheter

Question 42

State the criteria for the use of catheters

Answer 42

Symptomatic urinary retention, bladder outflow tract obstruction, undue stress caused by alternative management