5 - Incontinence pt 1

Question 1

how does living in an institution affect the prevalence of urinary incontinence?

Answer 1

Increases likelihood of UI -

Residential care - 25%
Nursing home care - 40%
Hospital care - 50-70%

Question 2

what is important to remember in treating incontinence?

Answer 2

it is a SYMPTOM with many causes - main objective should be to identify the cause and treat the cause

Question 3

3 causes of UI which are extrinsic to the urinary system?

Answer 3

environmental

habit

physical fitness

Question 4

2 causes of UI which are intrinsic to the urinary system?

Answer 4

problem with bladder

problem with urinary outlet

(often it is a combo of both)

Question 5

give 5 examples of extrinsic factors affecting UI?

Answer 5

Physical state and co-morbidities

Reduced mobility

Confusion (delirium or dementia)

Drinking too much or at the wrong time

Medications, e.g. diuretics

Question 6

what 3 things is continence reliant on?

Answer 6

1 : Bladder and Urethra
2 : Local Innervation
3 : CNS Connections

Question 7

name 2 functions of the bladder?

Answer 7

urine storage

voluntary voiding

Question 8

what is the detrusor of the bladder?

Answer 8

smooth muscle

Question 9

what type of muscle is internal urethral sphincter?

Answer 9

smooth

Question 10

what type of muscle is external urethral sphincter?

Answer 10

striated

Question 11

what is involved in urine storage?

Answer 11

detrusor muscle relaxation with filling to normal vol (400-600 mL)

sphincter contraction

Question 12

what is involved in voluntary voiding?

Answer 12

voluntary relaxation of external sphincter

involuntary relaxation of internal sphincter

contraction of bladder

Question 13

local innervation - what causes increased strength and frequency of contractions?

Answer 13

S2-S4 - parasympathetic n.

Question 14

local innervation - what causes detrusor m. to relax?

Answer 14

sympathetic T10 - L2 : Beta adrenoreceptor

Question 15

local innervation - what causes contraction of neck of bladder, and internal urethral sphincter?

Answer 15

T10-S2 - sympathetic : alpha adrenoreceptor

Question 16

local innervation - what causes contraction of pelvic floor muscle (urogenital diaphragm) and external urethral sphincter?

Answer 16

S2-S4 - somatic n.

Question 17

describe CNS connections involved in storage of urine?

Answer 17

Centres within the CNS inhibit parasympathetic tone, and promote bladder relaxation

Question 18

how is sphincter closure mediated?

Answer 18

reflex increase in a-adrenergic and somatic activity

Question 19

name 3 areas of CNS control of urine storage?

Answer 19

Pontine Micturition

frontal cortex

caudal part of spinal cord