continence and ageing Flashcards
SUMMARY what is urine incontinence? what is urge incontinence? what is stress incontinence? what is overflow incontinence?
1) urine involuntarily leaves the bladder
2) Urge_ overractive bladder
3) Stress- too much pressure
4) Overflow- incomplete emptying
• What is urinary incontinence?
-Involuntary loss of urine
Urinary incontinence is a problem where the process of urination, also called micturition,
happens involuntarily, meaning that a person might urinate without intending to.
Urinary incontinence is particularly problematic because it affects a person’s personal hygiene as well as their social life in a way that can be very limiting.
• What is urinary incontinence?
-Involuntary loss of urine
Urinary incontinence is a problem where the process of urination, also called micturition,
happens involuntarily, meaning that a person might urinate without intending to.
Urinary incontinence is particularly problematic because it affects a person’s personal hygiene as well as their social life in a way that can be very limiting.
• What route does urine take normally?
o Normally, urine is held in the bladder, which receives urine from two ureters coming down from the kidneys and then that urine leaves the bladder through the urethra.
o As urine flows from the kidney, through the ureters and into the bladder, the bladder expands into the abdomen.
o The bladder is able to expand and contract because it’s wrapped in a muscular layer, called the detrusor muscle, and within that, lining the bladder itself is a layer of transitional epithelium containing “umbrella cells”.
o When the urine is collecting in the bladder, there are basically two “doors” that are shut, holding that urine in.
o The first door is the internal sphincter muscle: made of smooth muscle and is under involuntary control, so it opens and closes automatically.
o Typically, that internal sphincter muscle opens up when the bladder is about half full.
o The second door is the external sphincter muscle: made of skeletal muscle and is under voluntary control, so it opens and closes when a person wants it to.
o This is the reason that it’s possible to stop urine mid-stream by tightening up that muscle, which is called doing Kegel exercises.
o Once urine has passed through the external sphincter muscle, it exits the body—in women the exit is immediate and in men the urine flows through the penis before it exits.
Why are these cells called umbrella cells?
- They’re called umbrella cells because they can physically stretch out as the bladder fills, just like an umbrella opening up in slow-motion.
- In a grown adult, the bladder can expand to hold about 750ml, slightly less in women than men because the uterus takes up space which crowds out the bladder a little bit.
What triggers the micturition reflex?// makes you pee??
o When stretch receptors in the bladder wall sense that the bladder is about half full, they send impulses to the spinal cord i.e. sacral spinal cord at levels S2 and S3 (aka micturition centre) and the brain, specifically two locations in the pons—the pontine storage centre and pontine micturition centre.
o The spinal cord response is part of the micturition reflex.
o It causes an increase in parasympathetic stimulation and decrease in sympathetic stimulation which makes the detrusor muscle contract and the internal sphincter relax.
o It also decreases motor nerve stimulation to the external sphincter allowing it to relax as well.
o At this point, urination would occur at this point, if not for the pons.
o The pons is the region of the brain that we train to voluntarily control urination.
o If we want to delay urination, or hold it in, the pontine storage centre overrides the micturition reflex, and when we want to urinate, the pontine micturition centre allows for the micturition reflex to happen.
- Urge incontinence,
- Urge incontinence, which is when someone has a sudden urge to urinate because of an “overactive bladder”, followed immediately by involuntary urination.
o This is typically due to an uninhibited detrusor muscle that contracts randomly.
o This usually results in frequent urination, especially at night.
o To treat urge incontinence, the focus is on decreasing the detrusor muscle activity.
Relaxation techniques to relax the bladder as well as antimuscarinic medications can decrease detrusor muscle contractions.
- Urge incontinence,
- Urge incontinence, which is when someone has a sudden urge to urinate because of an “overactive bladder”, followed immediately by involuntary urination.
o This is typically due to an uninhibited detrusor muscle that contracts randomly.
o This usually results in frequent urination, especially at night.
o To treat urge incontinence, the focus is on decreasing the detrusor muscle activity.
Relaxation techniques to relax the bladder as well as antimuscarinic medications can decrease detrusor muscle contractions.
- Stress incontinence
- Stress incontinence which is usually due to increased abdominal pressure that overwhelms the sphincter muscles and allows urine to leak out.
o Things that cause exertion, like sneezing, coughing, laughing—anything that
o puts pressure on the bladder.
o This is also relevant during pregnancy when a growing baby puts tremendous pressure on the bladder and causes stress incontinence in some women.
o The classic finding is urinary leakage with pressure applied to the abdomen.
o Stress incontinence treatments typically focus on strengthening the external sphincter muscle by doing things like Kegel exercises.
- Overflow incontinence
- Overflow incontinence which is typically caused by some sort of problem with emptying the bladder.
o This could be due to a blockage in urine flow, like a hypertrophic prostate in men which presses on the urethra or an ineffective detrusor muscle.
o Either way, the bladder doesn’t empty properly, and as a result the bladder fills up and overflows with urine which leaks through the sphincters.
o Typically this results in a weak or intermittent urinary stream or hesitancy where it takes a while for the urine to begin to flow because of a blockage in the path.
o Overflow treatments are aimed at re-establishing a clear pathway for urine flow.
o For example, that might be through catheterization or medications like alpha-blockers which can limit prostate enlargement.
o Finally, there are various conditions like diabetes, bladder cancer, Parkinson’s, and multiple sclerosis, as well as procedures such as prostatectomy or hysterectomy that can damage the nerves involved with the micturition reflex, ultimately leading to urinary incontinence.
what is the urinary tract made up of?
Urinary tract is made up of kidneys, ureters, bladder (detrusor muscle) urethra
What part of the brain controls the bladder?
Pontine Micturition Centre in the brain controls bladder
what do you need for the micturation processes to work effectively?
intact spinal chord
where is urine produced?
Urine is produced in the kidneys
what is hea;thy bladder capacity?
Bladder capacity between 300-750 mls
