Urinary Incontinence

tomi1's version from 2017-07-04 09:35

Section 1

Question Answer
urinary incontinenceinvoluntary loss of urine
prevalence of urinary incontinence30% in elderly- under-reported and under diagnosed - INCONTINENCE IS NOT A NORMAL SIGN OF AGEING
anatomy in bladder bladder: detrusor muscle + trigone (smooth triangular region of the internal urinary bladder formed by the two ureteral orifices and the internal urethral orifice)
IUS vs EUS type of muscle + controlIUS= sMM under involuntary control EUS= skeletal muscle under voluntary control
detrosur muscle innervation + nervous system + excitatory vs inhibiotry receptorshypogastric nerve, PNS, excitatory= M2, M3 inhibitory=B2,B3
innervation + nervous system + receptors IUSpelvic nerve, SNS, a1 receptors
EUS innervation + nervous system + receptorpudenal nerve, somatic, nicotinic
most common incontinence urge incontinence
how does pelvic floor help prevent voidingcloses IUS with rising abdominal pressure

Section 2

Question Answer
types of incontinenceurge, overflow, stress, mixed
etiology of incontinence bladder dysfunction or urethral incontinence
2 mechanisms of bladder dysfunctiondetrusor overactivity (urge) or underactivity (overflow)
2 mechanisms of uretheral dysfunctionlow tone in proximal IUS (anatomic stress) or intrinsic sphincter deficiency (due to bladder neck dysfunction)
reversible causes of incontinence DIAPPERSDelirium- Infection- Atrophic vaginitis-Psychosocial (depression)- Pharmacological-Excessive urine production- Restricted mobility- Stool impaction

Section 3

Question Answer
causes in women cystocele= prolapsed bladder
causes in men BPH/prostatic cancer
drugs causes incontinence diuretics-TCAs, alpha antagonists
foods causing incontinencecitrus fruits, tea, coffee, sugar, spicy foods
medical conditions causing incontinenceCHF-DM-high Ca

Section 4

Question Answer
urge incontinence causeoveractive bladder- idiopathic- neurogenic (dementia/MS)
urge incontinence symptomsurge(w/o warning)- frequency-nocturia-nocturnal enuresis
urge incontinence managementbehaviour or pharmacological
behavioural managment urge incontinencetimed voiding,pelvic floor exercises,weight loss, avoid bladder irritants
pharmacological management urge incontinenceantimuscarinics
examples anticholinergicsbotox, atropine,hyoscine
CI for antimuscarinicsacute angle glaucoma

Section 5

Question Answer
stress incontinence cause urethral dysfunction: anatomical= proximal urethra below level of pelvic floor or ISD(previous multiple surgery)
stress incontinence symptoms leakage with coughing/sneezing
stress incontinence lifestyle managementwx loss-smoking-pelvic floor exercises
stress incontinence pharmacological managementalpha agonists (Sudafed)
stress incontinence surgical mangementpubovaginal sling
examples alpha antagonistspseudoephedrine (sudafed) or TCAs

Section 6

Question Answer
overflow incontinence causeBladder outlet obstruction or underactive detrusor
overflow incontinence symptoms constant dribbling- frequency
overflow incontinence testhigh POST-RESIDUAL VOLUME> 200ml
overflow incontinence management menTURP
overflow incontinence management elderlyclean intermittent catheterisation

Section 7

Question Answer
History for incontinence onset, frequncy, pattern of incontinence
ass symptomsdysuria,urgency, nocturia, pad use
for females rec UTIs(pelvic prolapse), OBGYN history
for males prostatic obstruction, urethral strciture
general examination for incontinenceabdomen - PNS-PRE
questions for everyone VOIDING DIARY + bowel function + neurological (weakness/senation) + FAECAL INCONTINENCE
components of voiding diaryfluid intake + number of voids + quantity + incontinent episodes

Section 8

Question Answer
investigations incontinenceurine dip-PVR- urodynamics
normal amount urine passed per day 800-2000ml
normal PRV<50ml
how is PRV measured pelvic US/catheter
normal number of times to pass urine <10times

Section 9

Question Answer
patient education explaining diagnosis BEFORE MANAGEMENT
explaining urge incontinence to patient leak urine because bladder contracts w/o warning
explaining overflow incontinence to patientleak urine because flow of urine blocked out of bladder
explaining stress incontinence to patient leak urine because of increase pA on bladder from coughing,sneezing,exercise

Section 10

Question Answer
catheter defineflexible tube drains urine from bladder-uethra
indwelling catheter define catheter left in bladder
situations where indwelling catheter not used for incontinence1.bladder cancer 2.bladder stones 2.hydronephrosis 4.renal stones 5.renal failure

Section 11

Question Answer
who faecal incontinence affectswomen post childbirth
anatomical causes faceal incontinencepoor anal tone, bowel dysfunction, neurological dysfunction
innervation anuspudenal nerve s2-s4
investigationbristol stool chart, history, PRE, collateral history
surgical causes of poor anal tonehemorrhoids,fistulae
medical causes of bowel dysfunctionIBD, infection, laxatives, faecal impaction
neurological causes of faecal incontinenceMS,PD,DM, alcohol

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