Continence and Prolapse

Question 1

Briefly explain the structure of the bladder

Answer 1

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.

Question 2

What parts of the brain and spine are involved in continence?

Answer 2

Brain: pons
Spine: sacral spine, S2-S4

Question 3

What happens in the micturition reflex in the sacral spine?

Answer 3

• Increased parasympathetic activity
• Decreased sympathetic activity
• Decreased motor nerve

Question 4

What does the change in the parasympathetic and sympathetic nervous systems do?

Answer 4

It causes the detrusors to contract, thus pushing out urine, and the internal sphincter to relax, allowing the urine into the urethra

Question 5

What does the decrease in motor nerve do?

Answer 5

It relaxes the external sphincter, allowing urine to leave the body

Question 6

How does the pons prevent urination?

Answer 6

The pontine storage centre overrides the micturition reflex

Question 7

How does the pons allow urination?

Answer 7

The pontine micturition centre allows for the micturition reflex.

Question 8

What are the four different kinds of incontinence?

Answer 8

1. Urge
2. Stress
3. Mixed
4. Overflow

Question 9

What causes urge incontinence?

Answer 9

Uninhibited detrusor muscles contract irregularly and cause urination.

Question 10

How do you treat urge incontinence?

Answer 10

1. Bladder relaxation techniques

2. Antimuscarinic medications

Question 11

What causes stress incontinence?

Answer 11

Increased abdominal pressure causes leakage through the sphincters

Question 12

How do you treat stress incontinence?

Answer 12

Strengthen the sphincters through kegels

Question 13

What causes overflow incontinence?

Answer 13

There is a blockage in the urethra so the bladder can’t empty properly

Question 14

How do you treat overflow incontinence?

Answer 14

Re-establish the urethra pathway through surgery or medication, depending on the blockage.

Question 15

Four different kinds of prolapse

Answer 15

1. Cystocele
2. Rectocele
3. Enterocele
4. Uterine prolapse

Question 16

What is cystocele?

Answer 16

The downward movement of the bladder and prolapse of the anterior vaginal wall.

Question 17

What are the symptoms of cystocele?

Answer 17

Inability to void the bladder, urination during sex, higher risk of UTIs

Question 18

What is rectocele?

Answer 18

The downward movement and potential enlargement of the rectum and prolapse of the posterior vaginal wall

Question 19

What are the symptoms of rectocele?

Answer 19

Inability to void the bowels, haemorrhoids, impacted stool

Question 20

What is enterocele?

Answer 20

The downward of the small intestines through the pouch of Douglas

Question 21

What are the symptoms of enterocele?

Answer 21

Strangulation of the bowel

Question 22

What is uterine prolapse?

Answer 22

The downward movement of the uterus through the cervix and down the vagina

Question 23

What are the promoting factors of prolapse

Answer 23

• Erect posture
• Giving birth
• Ageing (oestrogen)

Question 24

What are the pre-disposing factors?

Answer 24

• Race

- Age

Question 25

C-section reference

Answer 25

Sandall et al., 2018 - there’s a lower chance of incontinence

Question 26

Risk factors of incontinence reference

Answer 26

Macarcthur et al., (2015) - older at first birth = increased risk; obesity = increased risk