Continence and Prolapse Flashcards
Briefly explain the structure of the bladder
The bladder is surrounded by detrusor muscles that expand as urine enters, with the umbrella cells in the transitional epithelium expanding to accommodate for urine. There is an internal sphincter that opens involuntarily when the bladder is half full and an external sphincter than opens voluntarily.
What parts of the brain and spine are involved in continence?
Brain: pons
Spine: sacral spine, S2-S4
What happens in the micturition reflex in the sacral spine?
- Increased parasympathetic activity
- Decreased sympathetic activity
- Decreased motor nerve
What does the change in the parasympathetic and sympathetic nervous systems do?
It causes the detrusors to contract, thus pushing out urine, and the internal sphincter to relax, allowing the urine into the urethra
What does the decrease in motor nerve do?
It relaxes the external sphincter, allowing urine to leave the body
How does the pons prevent urination?
The pontine storage centre overrides the micturition reflex
How does the pons allow urination?
The pontine micturition centre allows for the micturition reflex.
What are the four different kinds of incontinence?
- Urge
- Stress
- Mixed
- Overflow
What causes urge incontinence?
Uninhibited detrusor muscles contract irregularly and cause urination.
How do you treat urge incontinence?
- Bladder relaxation techniques
2. Antimuscarinic medications
What causes stress incontinence?
Increased abdominal pressure causes leakage through the sphincters
How do you treat stress incontinence?
Strengthen the sphincters through kegels
What causes overflow incontinence?
There is a blockage in the urethra so the bladder can’t empty properly
How do you treat overflow incontinence?
Re-establish the urethra pathway through surgery or medication, depending on the blockage.
Four different kinds of prolapse
- Cystocele
- Rectocele
- Enterocele
- Uterine prolapse
What is cystocele?
The downward movement of the bladder and prolapse of the anterior vaginal wall.
What are the symptoms of cystocele?
Inability to void the bladder, urination during sex, higher risk of UTIs
What is rectocele?
The downward movement and potential enlargement of the rectum and prolapse of the posterior vaginal wall
What are the symptoms of rectocele?
Inability to void the bowels, haemorrhoids, impacted stool
What is enterocele?
The downward of the small intestines through the pouch of Douglas
What are the symptoms of enterocele?
Strangulation of the bowel
What is uterine prolapse?
The downward movement of the uterus through the cervix and down the vagina
What are the promoting factors of prolapse
- Erect posture
- Giving birth
- Ageing (oestrogen)
What are the pre-disposing factors?
- Race
- Age
C-section reference
Sandall et al., 2018 - there’s a lower chance of incontinence
Risk factors of incontinence reference
Macarcthur et al., (2015) - older at first birth = increased risk; obesity = increased risk
