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Ger. Incontinence
Geriatrics Incontinence
| Question | Answer |
|---|---|
| Physical Health consequences of Urinary incontinence | Skin breakdown, recurrent UTI's, dehydration (patient decides not to drink) |
| Social Consequence of Urinary Incontinence | Stress on family, friends and caregivers. Predisposition to institutionalization |
| Psychological Effects of Urinary Incontinence | Isolation, Depresion, Dependency |
| Economic Burden of Urinary Incontinence | Supplies, Laundry, Labor, Management of complications |
| Causes of Incontinence | aging alone does not cause incontinence. Bladder capacity declines, residual urine increases, involuntary bladder contractions are common, dec. urethral resistance in females, prostate enlargement in men causes flow problems |
| Causes of acute and reversible incontinence | DRIP pneumonic. Delirium, Restricted mobility and rention, Infection Inflamation and Impaction. Polyuria, Pharmaceuticals |
| Stress incontinence Facts | involuntary loss of small volume urine with increased abdominal pressure (cough, laugh or exercise). Causes: weakness of pelvic floor musculature, bladder outlet or urethral sphincter weakness. more common in women |
| Urge Incontinence definition (AKA uninhibited bladder) | Leakage of urine (usually larger volumes) because of inability to delay voiding after sensation of bladder fullness is perceived |
| Common Causes of Urge Incontinence | Overactive neurogenic bladder: brain/cord injury, DM, MS, AD, Parkinson’s Detrusor motor instability: idiopathic, UTI, stones |
| Most common type of incontinence | Urge. May happen with or without warning |
| ________Leakage of urine throughout the day (usually small amounts) resulting from obstruction or atonic bladder | Overflow incontinence (outlet resistance too high) |
| Causes of Overflow Incontinence | Anatomic obstruction by prostate, stricture, mass or severe prolapseAcontractile bladder assoc. with diabetes or spinal cord injuryNeurogenic, assoc. with MS or other suprasacral spinal cord lesions |
| Least common cause of Incontinence | Overflow Incontinence. Patients don't feel the urge to void, there is continuous leakage or dribbling. Bladder doesn't empty completely. More common in Men |
| Urinary leakage associated with inability to toilet because of impairment of cognitive and/or physical functioning, psychological unwillingness, or environmental barriers | Functional Incontinence. Common causes: severe dementia, neuro disorders, psych disorders, physical barriers |
| Most common combination of mixed urinary incontinence | Stress UI and Urge UI |
| Women with multiple pregnancies are more likely to have | uterine prolapse |
| Key aspects of medical hx in an incontinent patient | medical conditions, past hx, meds, past GU hx, sx description, other lower urinary sx, other sx (neuro, psych, bowel, volume expanded state), environmental factors |
| PE in an incontinent patient | Mobility and dexterity, mental status, neurological, abdominal exam, rectal, pelvic, other signs of CHF |
| Rectal exam in an incontinent patient | perianal sensation, sphincter tone, impaction or masses, size and contour of prostate |
| Normal residual volume | =/<100 cc, >200 cc = overflow and requires urology consultation |
| History criteria for referral | recent hx of surgery or irradiation, relapse or rapid recurrence of UTI |
| PE criteria for referral | marked prolapse, marked prostatic enlargement and/or suspicion of cancer, severe hesitancy, straining and/or interrupted urinary stream. Postvoid residual, hematuria, uncertain diagnosis |
| Primary treatments for stress incontinence | pelvic floor exercises (kegel), topical estrogen, surgical bladder neck suspension |
| Primary treatments for urge incontinence | training procedures (kegels, behavioral, biofeedback), bladder relaxants, estrogen (if vaginal atrophy present) |
| Primary treatments for overflow incontinence | surgical removal of obstruction, medical management, intermittent catheterization |
| Primary treatments for functional incontinence | Behavioral therapies (habit training, scheduled toileting), environmental manipulations, incontinence undergarments/pads, endstage: catheter |
| Bladder retraining | stepwise, start with small intervals between the bathroom and slowly increase the time length of the intervals |
| When are bladder relaxants used? | generally to treat urge incontinence |
| When are cholinergics (bethanechol) used? | used in overflow incontinence with atonic bladder (MS, DM, spinal cord injury). First be sure there is no obstruction. These stimulate bladder contraction |
| ________are Used to treat overflow or urge incontinence associated with prostatic enlargement | alpha-adrenergic antagonists |
| complications of indwelling catheters | increased risk of UTIs, urosepsis, bladder stones, periurethral abscess, bacteremia, bacteriuria, bladder carcinoma |
| Fecal incontinence facts | F>M, up to 50% of NH patients, most patients never report it |
| Causes of Fecal incontinence | laxative overuse, neurological disorders (dementia, stroke, spinal cord disease, MS, DM), Colorectal disorders (diarrheal illness, rectal sphincter damage, prolapse, impaction, fistula) |
| PE of fecal incontinent patient | inspect perianal area, digital exam with valsalva maneuver, stool guaiac |
| Tx of fecal incontinence | depends on cause: treat diarrhea/constipation: stool normalization, diet, loperamide, lomotil for difficult cases, biofeedback, assisted defecation, surgery for refractive cases |
| Prevalence of constipation in elderly | >25-30%. Regular laxative use is common. Common complaints: hard stool, incomplete evacuation or straining |
| Management of Constipation | increase fluid, fibers, fresh produce. Judicious use of laxatives, timed toiletting, tap water enemas, glycerin suppositories |
Created by:
ltm12