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Urinary Incontinence Flashcards

(64 cards)

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1
Q

can incontinence be normal

A

incontinence is abnormal at any age

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2
Q

how to stop bladder voiding

A

higher centres (thalamus and cerebral cortex) can inhibit urination unless the bladder volume is very high

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3
Q

on-off switch for voiding

A

pontine micturition centre (PMC)

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4
Q

bladder emptying occurs when

A

parasympathetic outflow increases sharply and somatic/sympathetic tone decrease
bladder contracts, sphincters open and the urethra widens

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5
Q

normal amount of voids

A

5-7 per day (3-4 hourly)
0-2 per night

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6
Q

normal bladder volume

A

400-600mL

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7
Q

urge to void usually occurs when

A

bladder volume is 150-300mL

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8
Q

minimum fluid intake should be

A

> 1500mL/day unless restricted

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9
Q

changes with ageing

A
  • bladder capacity declines
  • post-void bladder volume increases
  • involuntary bladder contractions increase
  • lose the ability to concentrate urine at nigh (ADH secretion decreases) with nocturia 1-2 times per night
  • prostate size increases
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10
Q

medical complications of urinary incontinence

A

UTI and urosepsis, falls, fractures, pressure injuries, skin and perineal rashes (including cellulitis, dermatitis)

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11
Q

psychosocial complications of urinary incontinence

A

social isolation, stigmatisation, embarrassment, depression, sleed deprivation, sexual dysfunction, caregiver stress, institutionalisation risk

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12
Q

urinary tract infection

A

infection in any part of he urinary tract (kidney, ureters, bladder, urethra). typically lower tract

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13
Q

stress incontinence

A

involuntary leakage of urine on stress or exertion. usually die to weakness of the pelvic floor muscle and fascial support, or weakness/damage to the urethral sphincter

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14
Q

urgency

A

abrupt, strong often overwhelming need to urinate. occurs when the pressure in the bladder increases suddenly, whether or not the bladder is full. can lead to urge incontinence

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15
Q

transient incontinence

A

typically occurs in association with acute illness

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16
Q

causes of transient incontinence

A

DIAPPERS:

Delirium
Infection (UTI)
Atrophic vaginitis/urethritis
Pharmaceuticals
Psychological
Excessive urine output
Restricted mobility
Stool impaction

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17
Q

anticholinergics cause

A

urinary retention

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18
Q

cholinesterase inhibitors cause

A

incontinence

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19
Q

calcium channel blockers cause

A

constipation, fluid

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20
Q

ACE-inhibitors cause

A

cough

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21
Q

Diuretics cause

A

fluid retention/diuresis

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22
Q

alpha blockers cause

A

urethral relaxation

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23
Q

beta-agonists cause

A

retention

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24
Q

narcotics cause

A

constipation, sedation

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25
sedatives including alcohol cause
reductions in cognition/sedation
26
pathophysiological causes of incontinence
detrusor overactivity detrusor underactivity outlet obstruction outlet incompetence
27
detrusor overactivity is caused by
cystitis, cancer, stones, urethral obstruction, MS, stroke, alzeimer's, Parkinson's
28
detrusor under activity is caused by
idiopathic, chronic outlet obstruction, autonomic neuropathy, surgical damage, disc compression, plexopathy
29
outlet obstruction is caused by
prostate (benign prostatic hypertrophy or cancer), urethhral stricture, spinal cord lesion with detrusor-sphincter dyssynergia
30
outlet incompetence is caused by
prostate surgery, urethral hyper mobility, sphincter incompetence, radical prostatectomy with nerve damage
31
types of incontinence
stress, urge, mixed, overflow, functional
32
stress incontinecen
involuntary leakage of a small volume of urine during periods of raised intra-abdominal pressure such as exertion, sneezing or coughing. most commonly occurs with women, post party or post menopausal
33
urge incontinence
involuntary loss of urine shortly after the awareness of the need to empty the bladder but before the person can get to the toilet
34
mixed incontinence
combined stress and urge, the commonest type of incontinence in women aged above 60 years
35
overflow incontinence
involuntary leakage of small amounts of urine as a result of mechanical forces on an over-distended bladder
36
functional incontince
physical, cognitive and environmental factors may contribute factors outside the bladder
37
causes of stress incontinence
in women, causes include oestrogen deficiency, obesity, previous vaginal deliveries, previous surgery in men, causes include radiotherapy and prostatectomy
38
urge incontinence pathophysiology
involuntary loss of urine accompanied by or immediately preceded by urgency. detrusor has sudden, random contractions. unable to delay voiding after sensation go bladder fullness felt. more common with ageing
39
DHIC - detrusor hyperreflexia with impaired contractility
a subset of patients with detrusor over activity. emptying less than 1/3 of bladder volume, predisposed to urinary retention.
40
urinary retention may be caused by either
outflow obstruction or non-contractile detrusor
41
does a normal sized prostate on rectal exam and normal PVR (post residual void scan) exclude obstruction?
negatory
42
what can confirm/exclude obstruction
urodynamic studies
43
crucial points on history
effect on QOL need for assistance use of acids previous UTIs surgical and obstetric history bowel and fluid intake mobility alcohol, caffeine and smoking
44
crucial points on examnation
urine stained or malodorous clothing mobility cognition abdo exam - palpable bladder neuro exam - LL neurological signs cardiovascular exam - fluid status PR - anal tone, constipation (faeces), prostate (size, nodules)
45
urinary stress test
cough and observe for urine leakage
46
urodynamic studies are used when
used for complex patients not responding to treatment or patients with previous pelvic surgery or radiation used for younger patients if diagnosis is uncertain or used when surgery s being considered
47
contained incontinence
uses pads or appliances may be the best goal for some patients
48
treatment considerations
patient commitment to therapy tolerance and risk of adverse effects financial considerations
49
general management measures
avoid constipation avoid dehydration avoid excessive coffee avoid alcohol stop smoking use continence aids such as pads or bed protection use toileting regimes (timed toileting intervals usually 2-3 hourly) consider environmental factors (urinary bottle, toilet rials and aids, call bell) weight loss in overweight or obese women reduces episodes
50
behavioural/physcial interventions
bladder training, pelvic floor muscle exercises
51
bladder training
deferred voiding = delayed voiding for progressively longer periods of time so as to train the bladder to hold increasingly larger volumes of urine. recommended for symptomatic overactive bladder
52
pelvic floor muscle exercises
recommended for men and women with symptoms of overactive bladder, and for stress and mixed incontinence in women. can assess muscle contraction with ultrasound, or supplement with electrical stimulation.
53
fluid management
frequent intake of small amounts of fluid (120-150mL per hour) up to 2L per day avoid large episodic fluid boluses consider comorbidities eg. heart failure
54
how do anticholinergics help
significant adverse effects oxybutinin tablets and patches acts via mascurinic receptors - antispasmodic effects on bladder
55
how do beta-3 agonists help
mirabegron (betmega). non PBS stimulation of the beta-3 pathway promotes smooth muscle relaxation of the bladder to increase urine storage efficacy similar to anticholinergics causes HTN as adverse effect
56
oestrogens
low dose vaginal oestrogens (creams, tablets or rings) are approved for the treatment of vaginal atrophy. modest improvement in urinary incontinence in post-menopausal women compared to placebo
57
anticholinergic side effects
dry mouth, blurred vision, urinary retention, constipation, confusion (esp. in older patients) warn patients/carers
58
surgical management of stress incontinence
highly effective mid urethral sling is the most commonly performed surgery also retro pubic Burch colposuspension
59
surgical management of urge incontinence
prostate surgery (if this is the cause of the urge incontinence) percutaneous tibial nerve stimulation (acupuncture needle) - messages to sacral plexus botox A into the bladder sacral neuromodulation
60
overflow incontinence may be caused by
1. anatomical obstruction: prostate, stricture, cystocoele) 2. acontractile bladder: associated with diabetes or spinal cord injury (functional obstruction) 3. medication related
61
overflow incontinence is
leakage of small amounts of urine due to mechanical forces on an over distended bladder
62
management of overflow incontinence
catheter if significant infection then refer to urology. can try 'double voiding' if no catheter prostate enlargement due to BPH can be treated with drugs
63
prostate enlargement due to BPH can be treated with
prazosin, tamsulosin, duodart or surgery
64
duodarrt
combination of 5-alpha reductase inhibitor (dutasteride) plus alpha-blocker (tamsulosin)

geriatrics (8 decks)

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