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hi everyone > continence and incontinence > Flashcards

continence and incontinence Flashcards

1
Q

what are variables associated with urinary incontinence?

A
  • older age
    -BMI
  • poor self rated health
  • depression
  • childbirth (women)
    (Dr Colin Chandler, Lecture, 2024)
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2
Q

what is the anatomy of the female pelvis?

A
  • lies inferior to abdomen
  • 2 hip bones and sacrum
  • portal for passage of urine, faeces, childbirth and sex
  • supports the lower limb musculature and transfers forces between lower limb and trunk
  • maintains continence of pelvic floor
    (Stewart, 2018)
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3
Q

what are the differences between the male and female pelvis?

A

female
- False pelvis = wide and shallow
- Pelvic inlet = transversely oval
- Pelvic outlet = roomy and round
- Ischial tuberosities = everted
- Sacrum = short, wide, and flat
- Subpubic angle = 90 - 100 deg

Male
- False pelvis = narrow and deep
- Pelvic inlet = heart shaped
- Pelvic outlet = narrow and oblong
- Ischial tuberosities = inverted
- Sacrum = long, narrow, and convex
- Subpubic angle = 70 deg
(Stewart, 2018)

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4
Q

what are the different parts of a woman’s physiology?

A
  • uterus
  • bladder
  • pubis
  • vagina
  • clitoris
  • urethra
  • sacrum
  • rectum
  • anus
    (Stewart, 2018)
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5
Q

what are the different parts of a man’s physiology?

A
  • bladder
  • pubis
  • prostate
  • penis
  • scrotum
  • urethra
  • sacrum
  • rectum
  • anus
    (Dr Colin Chandler, Lecture, 2024)
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6
Q

what is the bladder?

A
  • muscular sac located within pelvis
  • stores urine
  • gets rid of urine
    (Dr Colin Chandler, Lecture, 2024)
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7
Q

how does the bladder get urine?

A
  • ureters from each kidney open into it
  • urine then gets rid through urethra
  • triangle is formed from these called trigone and is fixed to surrounding tissue
  • rest of bladder can then expand
    (Dr Colin Chandler, Lecture, 2024)
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8
Q

what is the bladder made of?

A
  • smooth muscle called detrusor muscle
  • adapted for mass contraction
    (Dr Colin Chandler, Lecture, 2024)
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9
Q

what is the lining of the bladder made of?

A
  • transitional epithelium, is urine proof, able to stretch paining protective function
  • contains urine safely in bladder
    (Dr Colin Chandler, Lecture, 2024)
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10
Q

why is the volume or urine produced under strict control?

A
  • body needs to maintain fluid balance to ensure homeostasis
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11
Q

what happens when the bladder starts to fill up?

A
  • around 200-300ml there will be a slight rise in pressure
  • reflex contractions of smooth muscle giving pressure peaks lasting seconds
    (Dr Colin Chandler, Lecture, 2024)
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12
Q

what is urinary reflex?

A
  • micturition initiated by stretch receptors in bladder wall feeding back to spinal urinary control centre in spinal cords
    (Dr Colin Chandler, Lecture, 2024)
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13
Q

how does the urethra look in men?

A
  • super long basically
  • leaves bladder surrounded by ring of smooth muscle forming internal urethral sphincter
  • passes though prostate then through pelvic floor where its surrounded by skeletal muscle forming external urethral sphincter
  • membranous part of urethra enters tissue of penis, has sharp bend and changes its name again to the sponge part of urethra and travels length of penis to external urethral orifice in the glands
    (Dr Colin Chandler, Lecture, 2024)
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14
Q

what does the urethra look like in women?

A
  • much shorter urethra, passes through pelvic floor skeletal muscle which forms external urethral sphincter
  • little distance between bladder and pelvic floor
  • no internal sphincter
    (Dr Colin Chandler, Lecture, 2024)
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15
Q

how is the bladder controlled?

A
  • in frontal lobe
    (Dr Colin Chandler, Lecture, 2024)
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16
Q

what is the pontine urinary control centre?

A
  • has two groups of neurones located in paramedic reticular formation of the rostral part of the pons
  • medial group contain pontine micturition centre and lateral group the pontine storage centre
    (Dr Colin Chandler, Lecture, 2024)
17
Q

how is sensory information regarding the bladder received?

A
  • from spinal cord on degree of bladder stretch, which relays information up to cortical urinary control centre
    (Dr Colin Chandler, Lecture, 2024)
18
Q

what happens when emptying is activated?

A
  • micturition centre coordinates the spinal centres and the autonomic response to give a sustained detrusor reflex sufficient enough to empty bladder
    (Dr Colin Chandler, Lecture, 2024)
19
Q

what is the spinal urinary control centre?

A
  • in the sacral portion of the spinal cord
  • involves the pudendal and the detrusor muscle, including sphincter and external sphincter via pudendal nerve allowing coordinated contraction of bladder muscle and relaxation of sphincters during micturition
    (Dr Colin Chandler, Lecture, 2024)
20
Q

what is stress incontinence?

A
  • caused by increased intra abdominal pressure (coughing, sneezing)
  • involuntary loss of urine without detrusor contraction
  • could have damage of pelvic floor due to childbirth
    (Voegeli, 2018)
21
Q

what is reflex continence?

A
  • detrusor hyper reflexia, and/or involuntary urethral relaxation resulting in loss of urine
  • common with total spinal lesion above the sacral region
  • sensory feedback from bladder to cortex means the individual is not consciously aware of their bladder
    (Voegeli, 2018)
22
Q

what is urge incontinence?

A
  • detrusor instability - often before bladder is full
  • urgent desire to urinate
  • often before bladder is full resulting in greater frequency
  • may continue during sleep
  • UTI can cause early voiding before bladder is full
  • happen in MD, PD, dementia or stroke
    (Voegeli, 2018)
23
Q

what is overflow incontinence?

A
  • involuntary loss of urine associated with over distension of bladder
  • usually due to incomplete emptying of bladder
  • flow can be slow and interrupted with some dribbling after voiding has finished
  • main factor is retention and over distention of bladder which can lead to discomfort
    (Voegeli, 2018)
24
Q

what is are functions of the colon?

A
  1. storage - until contents can be removed
  2. absorption - passage through colon is reduced in volume by net absorption of water to a semi or solid faeces which are stored in descending and sigmoid colon
  3. secretion
  4. synthesis
  5. elimination

(Barrie, 2018)

25
Q

what is the Bristol stool chart used for?

A
  • chart dietary factor and net absorption within colon
    (Barrie, 2018)
26
Q

how is the rectum closed?

A

distal end of rectum closed off by muscle fibres
(Barrie, 2018)

27
Q

how does the PNS contribute to the resting anal tone?

A

smooth muscle with autonomic intervention from the PNS contributes about 55% of resting anal tone
(Barrie, 2018)

28
Q

what is the colon made up of?

A
  • striated muscle which mainly slow twitch and includes fibres of pelvis floor looping around anus
  • muscles continuously active and provide around 20-30% resting anal tone
  • remaining tone provided by tissues and anal vascular cushions
    (Barrie, 2018)
29
Q

how sensory information carried in colon?

A
  • carried by fibres from pelvic floor and skin around anus
  • information from transition zone, rectum and lower 2/3rds of colon via parasympathetic fibres to sacral nuclei
    (Barrie, 2018)
30
Q

how does defecation controlled?

A
  • controlled by series of reflex controls called defecation reflexes
  • managed at conscious level by areas of frontal cortex
  • gut has its own enteric nervous system that coordinates movement and secretory process
  • colon will coordinate the mixing and mass movement activity of the smooth muscle but are under autonomic control from PNS
    (Barrie, 2018)
31
Q

how is defecation carried out?

A
  • mass movement from colon with a desire to defecate and relaxation of anal sphincters
  • sharp angle between sigmoid colon and rectum which acts like a sphincter which helps to prevent movement down into rectum
  • mass movement in colon will force faeces down into rectum, with pressure in rectum causing an immediate desire to defecate
    (Barrie, 2018)
32
Q

what is faecal incontinence?

A
  • involuntary loss of rectal contents through anal canal
    (Barrie, 2018)
33
Q

what can faecal incontinence lead to?

A
  • morbidity
  • reduced QoL
  • embarrassment
  • shame
  • depression
    (Barrie, 2018)
34
Q

why does faecal incontinence happen?

A
  • usually due to damage to sphincters, pelvic floor, or nerves and their control
  • can also be due to abnormal gastrointestinal function
  • can also be congenital, anatomical, neurological or function
    (Barrie, 2018)

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