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Renal Week 3 2017/18 > 10: Urinary incontinence > Flashcards

10: Urinary incontinence Flashcards

1
Q

What is incontinence?

A

Involuntary leakage of urine

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2
Q

Incontinence is very ___ for the patient.

A

embarrassing

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3
Q

Incontinence is more common in (men / women).

A

women

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4
Q

Why is incontinence more common in women?

A

They only have one urethral sphincter so rely on pelvic floor

Men have two

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5
Q

In micturition, the internal urethral orifice ___ and the bladder ___.

A

relaxes

contracts

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6
Q

During filling, the bladder muscle ___.

During voiding, the bladder muscle ___.

A

relaxes

contracts

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7
Q

What two structures fail to cause incontinence?

A

Either a

sphincter problem

overactive bladder muscle problem

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8
Q

Which receptors detect the filling of the bladder?

A

Stretch receptors

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9
Q

Which spinal nerves control the micturition reflex?

A

S2,3,4

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10
Q

What neuro mechanisms control

a) involuntary voiding
b) voluntary inhibition of voiding?

A

a) Micturition reflex (parasympathetics of S2,3,4)
b) Pons

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11
Q

What urinary problems occur in

a) CNS problems e.g Parkinson’s
b) severed spinal cord?
c) problems with the sacral spinal nerves?

A

a) Micturition reflex persists, so incontinence

b) Detrusor sphincter dyssnergia

c) Retention

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12
Q

What is urge incontinence?

A

Incontinence preceded by URGENCY

i.e desire to void

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13
Q

What is stress incontinence?

A

Involuntary voiding due to raised IAP e.g in coughing, laughing

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14
Q

What is overflow incontinence?

A

Involuntary urination associated with obstruction

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15
Q

What are types of incontinence causing

a) bedwetting
b) terminal dribble?

A

a) Nocturnal enuresis

b) Post-micturition dribble

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16
Q

Which neuro disorders increase your chances of incontinence?

A

Parkinson’s

MS

Stroke

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17
Q

What are some anatomical causes of incontinence?

A

Ectopic ureters

Fistulas

Traumatic childbirth

18
Q

Why does smoking cause incontinence?

A

Cough

19
Q

Why can obesity cause incontinence?

A

Weakened pelvic floor muscles

20
Q

Which drugs can cause urinary incontinence?

A

Alpha blockers

cause ureteric relaxation

21
Q

What are some important questions to ask in the history of someone with incontinence?

A

How often?

Volume?

When (day / night)?

ICE

22
Q

What examinations are done for someone with incontinence?

A

Abdominal exam

PR exam

PV exam

23
Q

What should be checked on PR exam of someone with urine obstruction?

A

Prostate gland

Anal tone

24
Q

Which investigation measures urine flow?

A

Uroflowmetry

25
Q

What does a slow urine flow rate indicate?

A

Obstruction

Weak detrusor muscle

26
Q

Why do women have a faster flow rate than men?

A

Shorter urethra

Less resistance

Higher pressure

27
Q

What can a patient keep to track their urinary symptoms?

A

Diary

28
Q

What investigation allows you to view the anatomy of the bladder?

A

Cystoscopy

for stricture, stone, tumour, fistula

29
Q

What scan would be used to check the kidneys in the case of hydronephrosis secondary to obstruction?

A

USS kidneys

30
Q

Anything which increases ____ pressure can cause stress incontinence.

A

intra-abdominal pressure

31
Q

What causes stress incontinence?

A

Weak pelvic floor muscles

Weak sphincters

32
Q

How is stress incontinence managed?

A

Lifestyle - avoid caffeine, stop smoking, optimise respiratory treatments, lose weight

Pelvic floor exercises

Duloxetine - rarely used drug which causes smooth muscle contraction

Surgery - narrowing of bladder neck

33
Q

Which symptom is associated with urge incontinence?

What causes it?

A

Urgency

Overactive bladder

34
Q

Apart from urgency, what symptoms are seen in urge incontinence?

A

Increased frequency

Nocturia

35
Q

Urge incontinence is associated with a ___ bladder.

A

overactive

36
Q

What should always be asked about when taking a fluid history from patients?

A

Water

Coffee/Tea

Alcohol

37
Q

How is urge incontinence managed?

A

Lifestyle management - fluid restriction, coffee, alcohol

Bladder training

Oxybutynin or tolterodine - anticholinergic, relaxes bladder smooth muscles

Surgery

38
Q

What type of incontinence is associated with obstruction?

A

Overflow incontinence

39
Q

What is the presenting symptom of chronic retention?

A

Painless abdominal mass

Reduced frequency

Nocturia

Potentially haematuria due to AKI

40
Q

How is overflow incontinence managed?

A

ADMIT:

Catheterise

Check renal function

Surgery

41
Q

What is an anatomical problem of the vagina which causes incontinence?

A

Vesicovaginal fistula

Renal Week 3 2017/18 (12 decks)

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