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MK SR INDEX CASES ELDERLY CARE > Urinary & faecal incontinence > Flashcards

Urinary & faecal incontinence Flashcards

1
Q

Define urinary Incontinence

A

The complaint of involuntary loss of urine after having gained the control on voiding.

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2
Q

LUTS: Storage symptoms:

A

• Frequency, Nocturia, Urgency, Incontinence

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3
Q

LUTS: Voiding symptoms:

A

• Slow stream, splitting/ spraying, intermittency, hesitancy, straining,
terminal dribble

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4
Q

LUTS: Post-micturation symptoms:

A

• Sense of incomplete evacuation,

post-micturation dribble

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5
Q

Gender diferences in incontinente

A

Storage LUTS >Voiding and post-micturation LUTS in both
sexes.

Stress incontinence more common in women Urge incontinence more common in men

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6
Q

Normal Micturation stages

A
  • Realize need to void urine
  • Plan the act
  • Recognize appropriate place • Negotiate environment
  • Manage clothing
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7
Q

Types of incontinence

A
  • Urge (OAB)
  • Stress
  • Overflow
  • Functional
  • Mixed
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8
Q

Risk Factors fir incontinance

A
  • Age: SI-peaks in middle age, Urge & mixed UI increase after 50 years in women
  • Heredity
  • Race: SUI in white women > Hispanic/ black
  • Physical activity
  • High BMI: Highest quartile of body mass-2-4 times more incidence of UI than lowest
  • Diet - High fat, low residue diet, Tea, fizzy drinks, water intake
  • Infection (Asymptomatic bacteriuria!!)
  • Smoking, cough, Chr. Lung diseases

Disability/disease related (Falls/Leg weakness/postural hypotension, Impaired mobility, visual impairment, Cognitive impairment, DM, constipation

Surgery: Prostatectomy, Hysterectomy • Hormone replacement worsens UI

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9
Q

Medications that increase risk of incontinence

A
  • Diuretics
  • Sedatives
  • Choline esterase inhibitors
  • Alpha blockers
  • Digoxin, frusemide: anticholinergic effects.
  • Antimuscarinics can worsen cognitive function and make incontinence worse.
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10
Q

Urge Incontinence mechanism

A
  • Detrusor muscle is overactive
  • Contracts unpredictably
  • Cytometry shows uninhibited contractions
  • Constant fear of not making to toilet in time
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11
Q

Definition of stress incontinence

A

Involuntary leakage of urine on
• effort or
• exertion or
• on coughing or sneezing

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12
Q

Mechanism of Urethral closure

A
  • Urethral Smooth muscle
  • Striated muscle of urethra
  • Mucosa and Connective tissue
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13
Q

Continence depends on what three factors:

A
  • Urethral closure pressure
  • Abdominal pressure
  • Transmission of the pressure
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14
Q

Overflow incontinence pathophysiology

A
  • Impaired voiding due to
  • Outflow obstruction e.g. BPH
  • Lower motor neuron lesion, i.e. neuropathic bladder
  • Usually sub acute or chronic, painless retention of urine. • Dribbling, Nocturia
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15
Q

Differentiating Urge Vs Stress UI

A

Urge UI
Sudden severe desire
Need to wake up at night

Stress UI
Making to the toilet
Leaking on physical activity

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16
Q

Examination for incontinance

A 
Examination
• Postural drop in BP • Neurological
• Cognition
• P/R and perinium
• Gait
17
Q

Investigations for incontinance

A
  • Urine dip & MSU
  • U&Es, Random glucose/ Hba1c
  • 3 day bladder diary
  • Bladder scan / Flow-meter / Urodynamics • USS KUB, Cystoscopy
  • WCC, CRP, Ca++ etc.
18
Q

Urge incontinence Management

A
  • Concept of cure Vs improvement
  • What is patient’s expectation?
  • Have realistic goals
  • Clear communication with carers and training them
  • Medicine is not always the answer! (Side effects can be very bothersome!)
19
Q

Potentially treatable problems causing incontinace:

A
  • Acute illness: e.g. delirium, UTI
  • Bowel: Constipation
  • Cognitive impairment: Dementia and depression
  • Drugs: Medication review
  • Environmental factors
  • Fluids: Inappropriate fluid intake
20
Q

Urge Incontinence management

A
  • Behavioural therapy
  • Prompted voiding/Scheduled toileting
  • Biofeedback/ ?? Electrical stimulation
  • Anticholinergic medication
  • Oxybutinin, Tolteradine, Solifenacin, Darifenacin and Fesoterodine
  • Adrenoceptor agonists
  • Mirabegron
  • Intra-vesical botulinum
21
Q

Stress Incontinence

- Conservative Management

A
  • Lifestyle modification
  • Weight loss
  • Stop smoking
  • Fluid management • Timed voiding
  • Pelvic floor muscle training, vaginal cones • Pharmacotherapy
  • Oestogens
  • Alpha agonists
22
Q

Stress Incontinence- Surgical management

A

Aims at
• Elevate bladder neck
• Support mid-urethra
• Increase urethral resistance

23
Q

Overflow incontinence management:

A
  • Bothersome LUTS, low risk of progression- Alpha blockers

* Bothersome LUTS, high risk of progression- Alpha blockers+5a-RI • LUTS and OAB- Alpha blockers + amtimuscarinic agents

MK SR INDEX CASES ELDERLY CARE (13 decks)

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