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incontinence (History (symptoms of urge, stress or LUTS, frequency, amount…
incontinence
History
symptoms of urge, stress or LUTS
frequency, amount of loss, progression and diration of continence
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management
dependent continence, independent continence, contained continence, and incontinence.
behavioural: toileting regimes: 2-3 hourly, assistant call bell, monitor bowels and avoid constipation, avoid dehydration, avoid caffiene containing drinks, continence aids.
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physical treatments: Bladder training, pelvic floor physio,
pharmacotherapy: anticholinergics, always check post void residula before commencing. side effects of dry mouth, constipation, urinary retention and cognitive problems.
Oxybutynin: M3 receptor antagonist, not specific for bladder M3. always check post void residual before and after starting.
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Surgical: support and elevate the bladder of the neck. advised after pelvic floor exercises. or for urge, then prostate treatment.
special populations
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Post operative
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Failed TOV: make patient stand adn run water, may be hypovolaemic <30ml/hr, need fluids and scan, check to see if constipated, or in pain, check scan in 2 hours, if patient uncomfortable then reinsert catheter.
Diabetes
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diabetic autonomic neuropathy , impaired bladder sensation and detrusor hypoactivity
Increased risk fo infection, peripheral vascular disease and stroke.
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investigations
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Urodynamics
MS, radiotherapy to plevis, bothersome incontinence pf unclear clause.
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