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Geriatrics Exam 2 > Incontinence > Flashcards

Flashcards in Incontinence Deck (29):
1

What is urinary incontinence?

- Unwanted leakage of urine
- Among 10 most common conditions
- Leading cause for admission to nursing homes
- Underdiagnosed- 1/2 of people with it never bring it up

2

Why care about UI?

- Significant impact on quality of life
- Increases dependence on care-givers
- Increases rate of serious medical conditions
- Increases risk for falls

3

Is UI more common in males or females?

Females!

4

How the lower urinary tract changes as you age

- Decreased bladder contractility
- Increased inhibited bladder contractions
- Diurnal urine output shifted later in the day
- Decreased bladder capacity
- Increased post void residual
- Decreased urethral closure pressure
- Vaginal mucosal atrophy (women)
- Benign prostatic hyperplasia (men)

5

Bladder innervation

3 parts
- parasympathetic from sacral nerve
-Sympathetic- further up in the spinal cord
- Pudendal- voluntary

6

Types of Incontinence

- Overflow- blockage in the bladder- fills up and can't empty itself- will be leakage when it gets too big
- Stress- increase in intraabdominal pressure- makes little leaks- any time they cough/sneeze/laugh they pee
- Urge - no leaking- just get the sense of urgency before it is all the way full

Mixed- stress and urge

7

Overactive Bladder

- A syndrome of urinary urgency WITH or WITHOUT incontinence, which is often accompanied by nocturia and urinary frequency.

8

Common causes of OAB in the elderly

- Meds
- Delirium
- Prostatectomy
- Excessive fluid intake
- Atrophic vaginitis
- Constipation
- UTI
- Glycosuria

9

First steps of OAB management

- Ask
- Review meds
- Screen for fall risks
- Screen for cognitive decline
- Screen for constipation
- Screen for UTI

10

Asking patients about incontinence increases reporting by _______

20%

11

Meds that frequently cause OAB/incontinence

- Loop diuretics
- Antipsychotics
- TCAs
- Alpha-blockers
- CCBs
- ACEI
- Gabapentin

12

Why does constipation cause Incontinence

- Blocks parasympathetic nerves and applies pressure on the bladder

13

Screening for UTI- high risk things in elderly

- Low estrogen
- Comorbidities
- Low immunity
- Low urinary defenses
- Limited fluid intake
- Catheters
- Dementia
- Constipation
- Poor mobility

14

Things to Look for in regards to incontinence during the history

- onset, duration, frequency
- Type
- quality of life
- Drinking habits
- Smoking and alcohol
- Medical history
- Gyne history
- Surgical history

15

Red flags for Incontinence

Abrupt onset, pelvic pain, hematuria

16

Stress test

- patient supine on table with full bladder
- Gauze pad in front of perineum
- Have them cough- then if they leak then its stress incontinence
- then place fingers on either side of the urethra and elevate it and cough again- if the elevation of the urethra stops the leakage, that confirms the stress incontinence

17

Post Void Residual Test

- Measures the amt of urine left in the bladder after voiding
- Obtained via straight catheter or US scan
- If over 200 ml- positive

18

Urodynamic tests

- Uroflowmetry
- Cystometric testing
- Leak point pressure measurement
- Electromyography
- Video urodynamic tests

19

Treatment goal

-To relieve the most bothersome aspect(s)

Stepped management strategy
- Lifestyle changes
- Behavioral therapy
- Medications
- Anti-incontinence rings and pessaries
- Surgery

20

Life style changes

- Address underlying illnesses
- Correct functional impairment
- Stop medication that contribute to UI
- Weight loss
- Avoid caffeine and alcohol
- Tobacco cessation in smokers with a stress UI

21

Behavioral Therapy

- Bladder diary
- Bladder training
- Pelvic floor exercises
- Biofeedback

22

Medications to use

Anticholinergics!
- annoying side effects- dry mouth, constipation
- Increased toxicity in elderly
- Low efficacy in clinical trials
- High non-adherence
- Use if behavioral therapy fails but monitor carefully

23

Mirabegron

- New treatment for overactive bladder and urge UI
- Targets beta3 pathway relaxing bladder spasms
- Increased risk of hypertension

24

Anti-incontinence rings and pessaries

- Been around 4000 years
- Used for stress/mixed UI
- Pessaries may make stress UI worse
- Hard to retain if weak perineum
- Varied results

25

Surgery

- Only for selective cases
- Very simple procedures
- For stress UI
--- bulking agents
--- Sling surgery

For Urge UI
--- Bladder pacemaker
--- Botox injections

26

How does bulking agents help?

- injects more "mass into the sphincters" so they plug better

27

Sling Surgery

- Only for stress UI
- Similar to Bulking agents, but more effective

28

Botox injections

- Targets bladder spasms
- Very expensive though
- paralyze the bladder wall so it does not respond to the stimulus anymore and the urgency can go away

29

Bladder Pacemaker

- Sacral nerve stimulation
- Similar to cardiac pacemaker