Evaluation and Treatment of Female Urinary Incontinence Flashcards
The external urethral sphincter is also called the ____________.
rhabdosphincter
The sympathetic response does what to the micturition system?
- Epinephrine on alpha-1 stimulates constriction of the urethral sphincter
- Epinephrine on beta-2 and beta-3 leads to relaxation of the detrusor muscle
When the bladder expands, the ___________ nerve sends sympathetic signals to the detrusor to relax.
hypogastric
What neurotransmitters are involved in the storage phase of micturition?
Norepinephrine and serotonin
Describe stress incontinence.
This occurs when physical stress (like sneezing or physical exertion) forces out urine through a weak urethra.
Describe urge incontinence.
Urge incontinence occurs when urination suddenly occurs with feelings of urgency.
_____________ is the most common cause of stress incontinence.
Urethral hypermobility
List the subtypes of urgency incontinence.
- Myogenic
- Neurogenic
- Idiopathic
People usually feel the first inklings of a need to urinate at ___________ mL.
People usually feel a “full bladder” at _____ mL.
People usually feel the need to void at ________ mL.
People usually feel an undeniable need to void at _________ mL.
100
200
250 - 400
500 - 800
The levator ani muscles ____________ with defecation and urination.
relax
The levator ani muscles rapidly __________ when coughing.
contract
What kind of muscle fibers are found in the levator ani muscle?
Types I (slow twitch) to maintain tone and type II to rapidly contract with changes in pressure.
_____________ is the most common side effect of anticholinergics.
Dry mouth
Anticholinergics are contraindicated in those with _______________.
closed-angle glaucoma
How common is female urinary incontinence?
15% to 50% of women are affected (even more in the elderly)
During the filling phase, the ____________ muscle relaxes to keep pressure low.
(highly elastic) detrusor
From which vertebral levels do the parasympathetic fibers of the urinary system originate?
S2 - S4
Note: the sympathetic fibers arise from T10 - L2.
Which nerve controls the striated muscles of the urethra?
The pudendal nerve (S2 - S4)
What kinds of epithelium line the urethra?
Stratified squamous (distally) and transitional (proximally)
The urethral smooth muscle is under ___________ control.
cholinergic and alpha-adrenergic
How is the urethra anatomically anchored?
- It passes through (and attaches to) the perineal membrane.
- It is anchored by ligaments to the pubic bone.
How can you diagnose a “hypermobile urethra”?
If you insert a cotton swab into the urethra and then ask the patient to bear down, the swab should not move more than 30º from its original plane. Moving more than that indicates hypermobility and increased likelihood of stress urinary incontinence.
True or false: people can normally inhibit the detrusor contractile reflex.
True. The detrusor muscle contracts when filled to a certain volume. Most people can inhibit this response to decrease intravesicular pressure while locating a place to void.
How is the pressure in the bladder calculated?
(abdominal pressure measured in vagina) –(pressure in bladder measured in catheter)
What is the utility of knowing the pressure of the bladder?
It can tell you if the detrusor muscle is overactive. For instance, if you ask a patient to Valsalva and the bladder pressure increases beyond the increase in abdominal pressure, then you know that the detrusor contracted inappropriately in response to the increased pressure.
What is thought to cause urethral hypermobility?
Weakening of the vaginal wall
Wakening at night to void is indicative of ____________ incontinence.
urge
What causes fistulas between the vagina and the urethra?
- Surgery
- Forceps use during labor
- Irradiation
All are thought to damage the vasculature of the urethra which leads to necrosis of the urethral wall.
What is the best test for diagnosing a ureterovaginal fistula?
Inject methylene blue into the urethra and then place a cotton swab into the vagina. If the cotton turns blue, then a fistula is likely present.
The best treatment for stress urinary incontinence is __________.
Kegels
If Kegels don’t work, then ____________ can also be used to treat SUI.
pessaries that “prop up” the vagina so that urethral hypermobility decreases
Why does estrogen help SUI?
It leads to thickening of the urothelium (just like the endometrium) which decreases the urethral lumen size.
___________ is the main neurotransmitter of the storage phase.
Norepinephrine
List the three subtypes of stress urinary incontinence.
- Type 1: SUI in the absence of urethral hypermobility
- Type 2: SUI due to urethral hypermobility (most common)
- Type 3: SUI due to intrinsic urethral sphincter defect
What is the mechanism of trospium?
M3 antagonist
