Continence Flashcards
Normal physiology of continence
Continence is maintained by the co-ordinated interaction of the bladder, urethra, pelvic floor muscles and nervous system
-low pressure-high volume
600ml capacity
Desire to void at 250ml
Continent if urethral pressure exceeds bladder pressure
Normal physiology micturition
Voluntary relaxation of striated muscle around the urethra
- > decreased urethral pressure
- > detruser contraction
The micturition cycle
Frontal cortex-> voluntary control
Pontine micturition centre-> coordinates detruser contract in with urethral relaxation
Parasympathetic-> bladder contraction s2-4
-> Ach release -> M3 r’s -> detruser contraction *antimuscarinics=retention
Sympathetic -> bladder filling t11-l2
-> bladder neck and urethra contraction
-> pudendal -> voluntary control of external sphincter
*a adrenergics=retention
*a blockers=stress incontinence
Urge incontinence
Detruser over activity with leakage of urine
Involuntary leakage accompanied by urge
Stress incontinence
Increased intra abdo pressure and weak pelvic floor muscles/urethral sphincter
Involuntary leakage when laughing, sneezing etc
Mixed incontinence
Stress and urge
Functional incontinence
Unable to reach the toilet in time
Overflow incontinence
Leakage from a full bladder
Reflex incontinence
Serious neuro impairment
Transient causes of incontinence
Delirium Infection Atrophic vaginitis Pharmacological agents Psychiatric disorders Excess urine output Restricted mobility Stool impaction
Causes of faecal incontinence
Faecal loading with overflow Lack of fluids and poor diet Lower GI ca Haemorrhoids Sphincter injury Dementia
Medications which cause incontinence
Alcohol Caffeine Sedatives-> less mobile + increased urge Antipsychotics-> " +" A blockers-> relax sphincter ACEi's -> cough Ca2+ channel blockers-> retention Opioids-> retention + constipation Antihistamines-> "+" Antidepressants-> "+" A agonists-> retention
Bladder irritants
Carbonated drinks Tea and coffee Artificial sweeteners Corn syrup Foods high in spice, sugar, acidity
Continence history extras
Risk factors Sexual health Obs+gynae LUTS Childhood urinary symptoms Bowels Diabetes Comorbidities Previous surgery Impact on patients life Fluids, caffeine, smoking Bladder control self assessment questionnaire
Continence examination
MMSE Chronic lung disease, CCF Abdominal masses Distended bladder DRE Vaginal atrophy+ pelvic floor muscles Neurological, gait, sensation
