Continence And Lower Urinary Tract

Question 1

Urine storage

Answer 1

Low pressure with perfect continence

Question 2

Urine emptying

Answer 2

Periodic complete urine expulsion, at low pressure, when socially convenient

Question 3

Motor nerves

Answer 3

Photo

Question 4

Sensory nerves

Answer 4

Photo

Question 5

Bladder filling

Answer 5

Sympathetic system is switched on

There are beta 2 and beta 3 receptors in the wall of the bladder and they’re activated to cause bladder relaxation

The hypogastric nerve also travels to the bladder neck and works on alpha receptors in that area
The alpha receptors are activating, this causes bladder neck contraction

At the same time the parasympathetic system is switched off and the M2, M3 receptors are not activated

At the same time the voluntary pudendal nerve is switched on and that causes tonic contraction of the striated external urethral sphincter

Question 6

Bladder emptying

Answer 6

Sympathetic system is switched off causes relaxation of the bladder neck

Parasympathetic system is switched on, which causes a contraction of bladder wall through the M2 and M3 receptors and main neurotransmitters is ACh and the voluntary muscles are switched off with the pudendal nerve being switched off and the striated sphincter relaxes

Question 7

Storage reflex/ bladder filling

Answer 7

1) Distention of the bladder produces low level bladder afferent firing

2) Triggers guarding reflex-
A- sympathetic outflow in the hypogastric nerve to bladder outlet/neck

The hypogastric nerve also travels to the bladder neck and works on alpha receptors in that area
The alpha receptors are activating, this causes bladder neck contraction

B- pudendal outflow to external urethral sphincter

At the same time the voluntary pudendal nerve is switched on and that causes tonic contraction of the striated external urethral sphincter

3) Sympathetic outflow also inhibits contraction of the detrusor muscle (muscle in wall of bladder)

There are beta 2 and beta 3 receptors in the wall of the bladder and they’re activated to cause bladder relaxation

A region in the Rostral pons pontine storage centre might increase striated urethral sphincter activity

Question 8

Voiding reflex/ bladder emptying

Answer 8

1) Intense bladder-afferent firing in the pelvic nerve

2) Triggers spinobulbospinal reflex
A- afferent signalas passed to peraquedictal gray (PAG)
B- pontine micturition centre (PMC) activated

3) PMC ‘on/off’
A- Parasympathetic outflow to bladder and urethral smooth muscle (green)
B- inhibits the sympathetic and pudendal outflow to bladder outlet/neck so striated sphincter relaxes

Parasympathetic system is switched on, which causes a contraction of bladder wall through the M2 and M3 receptors and main neurotransmitters is ACh

Question 9

Classification of lower urinary tract dysfunction

Answer 9

Failure to store or to void is due to bladder and outlet

Question 10

Types of incontinence

Answer 10

Stress

Urgency

Mixed

Question 11

Stress incontinence

Answer 11

Loss of urine with excretion or sneezing or coughing

Question 12

Urgency incontinence

Answer 12

Leakage accompanied by or immediately preceded by urinary urgency

Question 13

Mixed incontinence

Answer 13

Loss of urine associated with urgency and also with excretion, effort, sneezing or coughing

Question 14

Overflow incontinence

Answer 14

Leakage of urine associated with urinary retention

Question 15

Total incontinence

Answer 15

Is the complaint of leakage

Question 16

Stress urinary incontinence theory 1

Answer 16

Urethral hyper mobility age/parturition weakness in pelvic floor muscle/ connective tissue

Weakened vaginal hammock
Impaired pressure transmission

Question 17

Theory II

Answer 17

Intrinsic sphincter deficiency due to direct muscle Injury or nerve injury

Question 18

Urgency urinary incontinence

Answer 18

Urgency is a sensory symptom

Urgency urinary incontinence is variably associated with detrusor over activity

Detrusor overactivity= non volitional detrusor contraction

Can be idiopathic or neurogenic

Question 19

Total incontinence

Answer 19

Caused by a fistula between vagina and bladder (in this case)
Prolonged second stage of labour causes pressure on bladder wall which causes damage in urinary sphincter- so bad incontinence

Question 20

Reversible causes of incontinence

Answer 20

D- delirium
I- infection
A- strophic vaginitis/urethritis
P- psychological
P- pharmacological (diuretics, narcotics)
E- endocrine/ excessive urinary output
R- restricted mobility
S- stool impaction