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SNAP SAMP:

 

You are covering for a long term care facility and a nurse asks you to assess a 86 year old man who is presenting with urinary incontinence.

 

 

Questions:

 

  1. Name 3 types/classifications of urinary incontinence.
     

  2. Describe 4 transient, short term or modifiable causes of incontinence.  
     

  3. Name 4 conservative management strategies to advise patients who are presenting with urinary incontinence.
     

  4. Name 2 medications that can be used for patients presenting with urge incontinence/over active bladder.

 

 

Answers:

 

  1. - Urge incontinence
    - Stress incontinence
    - Overflow/retention
    - Mixed, functional
    - Neurogenic
     

  2. Use mnemonic DIAPERS:

    Delirium
    Infection (UTI)
    Atrophic vaginitis
    Pharmaceuticals (anticholinergics, sedatives, hypnotics)
    Endocrine (diabetes)
    Retention (BPH)/Reduced mobility
    Stool impaction (constipation)

    Others to consider: excessive alcohol or caffeine intake
     

  3. - Prompted/scheduled voiding
    - Urge suppression/delayed voiding
    - Kegel exercises (although evidence for this is very limited)
    - Pelvic physiotherapy
    - Weight loss
    - Limit caffeine intake
    - Limit alcohol intake
    - Bowel regimen
    - Limit fluids after supper
     

  4. - Anti-muscarinic drugs (oxybutynin, tolterodine, fesoterodine, darifenacin, solifenacin)
    - Beta-adrenergic agonists (mirabegron)
    - For women; intravaginal estrogen
    - TCA (nortriptyline, imipramine)

 

 

 

 

 

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