Continence and Incontinence Flashcards
1
Q
What variables are associated with urinary incontinence?
A
- older age
- BMI
- poor-rated self health
- depression
- childbirth
2
Q
What is the anatomy of the female pelvis?
(Hall, 2021)
A
- lies inferior to the abdomen
- portal for passage of urine, faeces, childbirth and sex
- supports the lower limb musculature and transfers force between lower limb and trunk
- maintains continence of pelvic floor
3
Q
What are the differences between the male and female pelvis?
(Hall, 2021)
A
- females have a wide and shallow pelvis while mens are narrow and deep
- female have oval pelvic inlet and male have heart shaped
- female pelvic outlet is round and roomy, male is narrow and oblong
- female sacrum is short, wide and flat, amle is long, narrow, and convex
- subpubic angle in female is 90-100º, 70º in male
4
Q
List some parts in a womens pelvic physiology.
(Hall, 2021)
A
- uterus
- bladder
- vagina
- clitoris
- urethra
- pubic
- sacrum
- rectum
- anus
5
Q
List some parts in a mans pelvic physiology.
(Hall, 2021)
A
- bladder
- pelvis
- prostate
- penis
- scrotum
- urethra
- sacrum
- rectum
- anus
6
Q
What is the bladder?
(Hall, 2021)
A
- a muscular sac located within the pelvis
- stores and disproses of urine
7
Q
How does urine leave the body?
(Hall, 2021)
A
- ureters from the kidneys open into the bladder
- urine then travels from the bladder out of the body through thr urethra
- the urethra and ureters from a traingle called the trigone which is fixed to surrounding tissie
- this allows the rest of the bladder to stretch and expand when filled with urine
8
Q
What is the bladder made of?
(Hall, 2021)
A
- smooth muscle called detrusor muscle
- it is adapted for mass contraction
9
Q
What is the lining of the bladder made of?
(Hall, 2021)
A
- transitional epithelium
- this is urine proof protecting the body from harmful substances found in the urine e.g. toxins, drugs,
- allows the bladder to stretch
10
Q
Why is the volume of urine produced under strict control?
(Hall, 2021)
A
the body needs to maintain fluid balance to ensure homeostasis
11
Q
What happens when the bladder begins to fill up?
(Hall, 2021)
A
- there is a slight rise in pressure as it fills until there is about 300-400 ml when the pressure begins to increase rapidly as the bladder wall stretches
- as the pressure rises you start to get reflex contraction of the smooth muscle giving you pressure peaks
- this reflex contraction is the micturition reflex, initiated by stretch receptors in the bladder wall feeding back to the spinal urinary control centre in the sacral segments of the spinal cord and stimulating detrusor muscle contraction via parasympathetic nerves.
- the pressure waves detected by the stretch receptors feed on up to the cortex and our consciousness making us aware of the need to empty the bladder.
12
Q
Describe the urethra in men.
(Hall, 2021)
A
- long
- leaves the bladder surrounded by a ring of smooth muscle, fomring the internal urethal sphincter
- passes down through the prostate and then through the pelvic floor where it is surrounded by skeletal muscle forming the external urethral sphincter.
- as the membranous part of the urethras enters the penis it has a sharp bend and travels the length of the penis to the external urethral orifice in the glans.
13
Q
Describe the urethra in women.
(Hall, 2021)
A
- much shorter urethra, around 3.5 cm.
- passes through the pelvic floor skeletal muscle which forms the external urethral sphincter, there is little distance between the bladder and the pelvic floor and there is no internal sphincter.
14
Q
Where is the cortical urinary control centre found?
(Hall, 2021)
A
- in the frontal lobe
- reveices information from other areas of the cortex and thalamus
- provides decision making and voluntary control over micturition, controlling the external urethral sphincter,
- can decide whether to allow bladder emptying or continue inhibiting the pontine centres so preventing emptying.
15
Q
What are the Pontine urinary control centres?
(Hall, 2021)
A
- two groups of neurones located in the pons
- Sensory information is received from the spinal cord on the degree of bladder stretch, it relays this information on up to the Cortical UCC.
- If emptying is activated, then the micturition centre coordinates the spinal centres and the autonomic response to empty the bladder.
16
Q
What is the spinal urinary control centre?
(Hall, 2021)
A
- Involves the pudendal and the detrusor motor nuclei.
- These control the detrusor muscle, internal and external sphincter via the pudendal nerve
- This allows a coordinated contraction of the bladder muscle (detrusor) and relaxation of the sphincters during micturition (urination).
17
Q
What is the autonomic nervous sustems role in bladder emptying?
(Hall, 2021)
A
- autonomic sensory fibres – parasympathetic feedback to the spinal UCC information on the degree of stretch of the bladder wall
- sympathetic feedback pain sensation from the bladder distension is sent to the Pontine urinary control centre
18
Q
What is the parasympathic and sympathic nervous system role in emptying the bladder?
(Hall, 2021)
A
The parasympathetic system stimulates bladder emptying through detrusor contraction and inhibiting urethral smooth muscle.
The sympathetic system does the opposite, stimulating contraction of urethral smooth muscle and relaxing detrusor muscle, so inhibiting urination.
19
Q
What is stress incontinence?
(Voegeli, 2018)
A
- caused by increased intra-abdominal pressure
- involuntary loss of urine without detrusor contraction
- could be due to damage of pelvic floor though things like childbirth
20
Q
What is urge incontinence?
(Voegeli, 2018)
A
- detrusor instability- often before bladder is full
- urgent desire to urinate
- results in greater frequency
- may continue during sleep
- UTI can cause early voiding before bladder is full
- common in MD, PD, dementia or stroke
21
Q
What is reflex incontinence?
(Voegeli, 2018)
A
- hyperreflexia of detrusor muscle or involuntary urethal 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
22
Q
What is overflow incontience?
(Voegeli, 2018)
A
- involuntary loss of urine associated with over distention 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 distension of bladder which can lead to discomfort
23
Q
What are the functions of the colon?
(Hall, 2021)
A
- Storage- until contents can be removed
- Absorption- passage through colon is reduced in volume by net abdoprtion of water to a solid or semi solid faeces
- Secretion
- Synthesis
- Elimination
24
Q
What is the Bristol stool chart used for?
(Hall, 2021)
A
- chart dietary factor and net absorption within colon
- compare different types of stool
25
How is the rectum closed?
(Hall, 2021)
by the anal sphincters, with muscle fibres arranged in a ircle acting like a purse string
26
What is the internal sphincter made of and how is it controlled?
(Hall, 2021)
- made of smooth muscle
- autonomic control by parasymathetic nervous system
- accounts for 55% of resting anal tone
27
What is the external sphincter made of and controlled?
(Hall, 2021)
- striated muscle
- voluntary control by the pundendal nerve and sacral nerves
- muscles are constatly acrtive accounting for 30% of resting anal tone- remainder comes from surrounding tissues and vascular cushions
28
How is sensory information carried in the colon?
(Hall, 2021)
- carried by fibres from pelvic floor and skin around anus
- information from transition zone, rectum, and lopwer 2/3 of colon is carried by parasympathetic fibres to sacral nuclei
29
How is defecation controlled?
(Hall, 2021)
- by a series of reflex controls called defecation reflexes
- consciously managed by areas of frontal cortex
- gut has its own nervous system in insestines that coordinates movement and secetory processes
- colon will coordinate the mixing and mass movement activity of smooth muscle but is under autonomic control by the PNS
30
How is defecation carried out?
(Hall, 2021)
- mass movement from colon with a desire to defecate and relaxation of anal sphincters
- mass movement in colon will force faeces down into rectum, with pressure in rectum causing an immediate desire to defecate
- sharp angle between sigmoid colon and rectum which acts like a sphnicter helping to prevent movement down into rectum
31
What is faecaln incontinence?
(Hall, 2021)
involuntary loss of rectal contents through anal canal
32
What can faecal incontinence lead to?
(Hall, 2021)
- morbidity
- reduced QoL
- embarrassment
- shame
- depression
33
Why does faecal incontinence happen?
(Hall, 2021)
- usually due to damaged sphicters, pelvic floor, or nerves and their control
- can also be due to abnormal gastrointestinal function
- may be congenital, anatomical, neurological, or function of the system e.g. IBS, malnutrition, prolaspe etc.
34
List some references for continence and incontinence.
- (Hall, 2021)
- (Voegeli, 2018)
