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1 in 4 New Zealanders live with incontinence.
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Choose the incorrect statement.
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25% of younger women have experienced incontinence.
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34% of older women have experienced incontinence.
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12% of older women experience daily incontinence.
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25% of older men experience daily incontinence.
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22% of older men have experienced incontinence.
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5% of younger men have experienced incontinence.
Frage 3
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Choose the incorrect statement.
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92.5% of two year olds do not have bladder control.
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11% of five year olds do not have bladder control.
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3.3% of 8 year olds do not have bladder control.
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The percent of children with nocturnal enuresis is always lower than the percent of children of the same age without bladder control.
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Which of these is not a risk factor for incontinence?
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Incontinence is under-diagnosed and under-treated despite the majority of urinary incontinence being easy to treat and resolve.
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Why is Incontinence Important? It has:
• Social stigma - which leads to [blank_start]restricted[blank_end] activities and [blank_start]depression[blank_end]
• Medical complications - [blank_start]skin[blank_end] breakdown, increased urinary tract [blank_start]infections[blank_end]
• Institutionalisation - UI is the second leading cause of [blank_start]nursing home[blank_end] placement
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restricted
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depression
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skin
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infections
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nursing home
Frage 7
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Red flags
• [blank_start]haematuria[blank_end] (blood in the urine)
• recurrent [blank_start]urinary tract infections[blank_end] (3 or more in last 6 months)
• loin [blank_start]pain[blank_end] (pain in the lower back)
• recurrent catheter [blank_start]blockages[blank_end]
• hydro nephrosis or [blank_start]kidney stones[blank_end] on imaging
• biochemical evidence of [blank_start]renal[blank_end] deterioration.
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haematuria
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urinary tract infections
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pain
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blockages
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kidney stones
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renal
Frage 8
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Micturition/urination:
An autonomic spinal cord reflex controlled by higher brain centres(Pons - [blank_start]facilitates[blank_end]. Cerebral cortex – [blank_start]inhibits[blank_end].) Detrusor muscle constricts to expel urine, relaxes to allow filling. Has an internal sphincter which is [blank_start]involuntary[blank_end] and an external sphincter which is [blank_start]voluntary[blank_end] and deep in pelvic floor muscle. Stretch receptors send signals to the brain and sacral segment.
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facilitates
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inhibits
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involuntary
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voluntary
Frage 9
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At 150-300mL you first have the urge to void urine and at about 700mL you can no longer suppress urination.
Frage 10
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Potentially Reversible Causes of incontinence:
D- [blank_start]Delirium[blank_end]
I - [blank_start]Infection[blank_end]
A- [blank_start]Atrophic[blank_end] vaginitis or
urethritis
P -[blank_start]Pharmaceuticals[blank_end]
P - [blank_start]Psychological[blank_end] disorders
E - [blank_start]Endocrine[blank_end] disorders
R- [blank_start]Restricted mobility[blank_end]
S - [blank_start]Stool[blank_end] impaction
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Delirium
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Infection
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Atrophic
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Pharmaceuticals
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Psychological
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Endocrine
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Restricted mobility
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Stool
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Which of these is NOT a drug which may cause incontinence?
Frage 12
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3 types of incontinence:
1. [blank_start]Overflow[blank_end] - urethral blockage
2. [blank_start]Stress[blank_end] - abdominal pressure and weak pelvic floor
3. [blank_start]Urge[blank_end] - oversensitivity from infection or neuro disorders
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Overactive bladder (OAB) is defined as urgency that occurs with urgency UI and usually with frequency and nocturia.
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Men are more likely to experience urge incontinence.
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Stress Incontinence
• Most common type in [blank_start]women < 75 years[blank_end] old
• Occurs with increase in abdominal [blank_start]pressure[blank_end]; cough, sneeze, laughing, etc.
• Hypermotility of bladder neck and urethra; associated with aging, hormonal [blank_start]changes[blank_end], trauma of [blank_start]childbirth[blank_end] or pelvic surgery (85% of cases)
• [blank_start]Intrinsic[blank_end] sphincter problems; due to pelvic/incontinence surgery, pelvic radiation, trauma, neurogenic causes (15% of cases)
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women < 75 years
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pressure
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changes
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childbirth
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Intrinsic
Frage 16
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Urge Incontinence
AKA detrusor [blank_start]hyperactivity[blank_end], detrusor instability, irritable bladder, spastic bladder.
• Most [blank_start]common[blank_end] cause of UI >75 years of age
• [blank_start]Abrupt[blank_end] desire to void cannot be suppressed
• Usually [blank_start]idiopathic[blank_end]
• Causes: infection, tumor, stones, atrophic vaginitis or urethritis, stroke, Parkinson’s Disease, dementia
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hyperactivity
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common
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Abrupt
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idiopathic
Frage 17
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Overflow Incontinence
• Over distention of bladder
• Bladder outlet [blank_start]obstruction[blank_end]; stricture, BPH, cystocele, fecal [blank_start]impaction[blank_end]
• Non-contractile bladder ([blank_start]hypoactive[blank_end] detrusor or atonic bladder); diabetes, MS, spinal injury, medications
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obstruction
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impaction
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hypoactive
Frage 18
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Functional Incontinence does not involve the lower urinary tract and is the result of psychological, cognitive or physical impairment.
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Lifestyle choices
• Reduce or eliminate [blank_start]caffeine and alcohol[blank_end]
• Drink 6 to 8 glasses of water daily
• Quit [blank_start]smoking[blank_end]
• [blank_start]Weight[blank_end] control
• Follow a healthy diet high in [blank_start]fibre[blank_end]
• Reduce physical [blank_start]barriers[blank_end] to toilet
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caffeine and alcohol
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smoking
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Weight
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fibre
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barriers
Frage 20
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Non-pharmacological Treatment Options:
• Bladder [blank_start]training[blank_end]
• Patient [blank_start]education[blank_end]
• [blank_start]Scheduled[blank_end] voiding (Regular scheduled pattern of voiding where the intervals between voiding are gradually [blank_start]increased[blank_end], reduces irritability of the bladder, reverses bad [blank_start]habits[blank_end])
• Positive reinforcement
• Pelvic floor exercises ([blank_start]Kegel Exercises[blank_end])
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training
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education
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Scheduled
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increased
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habits
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Kegel Exercises
Frage 21
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Pharmacological Interventions:
• Anti[blank_start]cholinergics[blank_end]: These medications can calm an [blank_start]overactive[blank_end] bladder and may be helpful for urge incontinence. Examples include [blank_start]oxybutynin[blank_end], tolterodine
• [blank_start]Alpha[blank_end] blockers: In men with urge or overflow incontinence, these medications [blank_start]relax[blank_end] bladder neck muscles and muscle fibres in the prostate and make it [blank_start]easier[blank_end] to empty the bladder. Examples include [blank_start]tamsulosin, doxazosin, terazosin[blank_end].
• Topical estrogen. For women, applying [blank_start]low[blank_end]-dose, topical estrogen in the form of a vaginal cream, ring or patch may help [blank_start]tone[blank_end] and rejuvenate tissues in the urethra and vaginal areas.
Frage 22
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Interventional therapies:
• Bulking material injections: A synthetic material is [blank_start]injected[blank_end] into tissue surrounding the urethra. The bulking material helps keep the urethra [blank_start]closed[blank_end].
• Botulinum toxin type A (Botox): Injections of Botox into the [blank_start]detrusor[blank_end] muscle may benefit people who have an overactive bladder.
• Nerve stimulators: A device resembling a pacemaker is [blank_start]implanted[blank_end] under your skin to deliver painless [blank_start]electrical[blank_end] pulses to the nerves involved in bladder control (sacral nerves).
Surgical Interventions:
- [blank_start]Sling surgery[blank_end] is reported to “cure” 4 out of 5 cases, but success rate drops to 50% after [blank_start]10[blank_end] years
- [blank_start]Bladder neck suspension[blank_end] adds support to the bladder neck and urethra, reducing the risk of stress incontinence
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injected
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closed
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detrusor
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implanted
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electrical
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Sling surgery
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10
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Bladder neck suspension
Frage 23
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Pessaries -
• Urethral insert: a small, tampon-like [blank_start]disposable[blank_end] device inserted into the
urethra before a specific [blank_start]activity[blank_end], such as tennis, that can trigger incontinence. The insert acts as a plug to prevent [blank_start]leakage[blank_end], and is removed before urination.
• Pessary: a stiff ring that you insert into your vagina and wear all [blank_start]day[blank_end]. The
device is typically used in someone who has a [blank_start]prolapse[blank_end] that is causing
incontinence. The pessary helps hold up your bladder, which lies near the
vagina, to prevent urine leakage.
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disposable
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activity
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leakage
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day
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prolapse