Female incontinence Flashcards
What comprises the upper urinary tract?
What is its fucntion?
Kidneys and ureter, low pressure distensible conduit with intrinsic peristalsis.
Its job is to transport urine from nephrons via ureters into the bladder
What comprises the lower urinary tract?
What is its function
The bladder urethra and sphincters. Fills at a rate of 0.5-5mls per minute.
Low pressure storage system, allows for efficient expulsion of urine at appropriate place and time.
What does the vesico-ureteric mechanism do?
Protect nephrons from any damage secondary to retrograde transmission of back pressure or infection from the bladder
How is the bladder innovated
What is the function of the bladder
Hypogastric nerve (sympathetic T10-L2) stimualtes storage of urine Pelvic nerve (parasympathetic S2-S4) is involved with relaxation of the external urethral sphincter
To accommodate an increasing volume of filling at a constantly low pressure. Inhibition of contractions give rise to an increased awareness of filling.
What sort of impact does cortical activity have on the bladder?
Activates a reciprocal guard reflex by rhabdosphincter contraction, this increases sphincter contraction and resistance
It activates a sympathetic pathway that uses reciprocal innervation of the parasympathetic pathway. it mediates contraction of the bladder base and the proximal urethra
How does the bladder empty
Detrusor (smooth muscle) contraction. Sphincter co-ordination. There is a cortical influence that activates the parasympathetic pathway and inhibits the sympathetic pathway
What are the three different types of urinary incontinence?
Urinary incontinence- any involuntary leakage of urine
Urge urinary incontinence- involuntary leakage accompanied by or immediately preceded by urgency
Stress urinary incontinence- inviluntary leakage on effort or exertion, on sneezing or coughing
Mixed urinary incontinence- Involuntary leakage accompanied by or immediately preceded by urgency and on effort or exertion or on sneezing or coughing
How does urinary incontinence impact quality of life
Reduces relationships and activities
impairs emotional and psychological well being and sexual relationships
What are the risk factors for urinary incontinence (5)
Age, children, menopause, smoking, medical problems, increased abdominal pressure, pelvic floor trauma, denervation, connective tissue disease, surgery
What should be asked when taking a history from a woman with suspected urinary incontinence (5)
Age, children, smoking,
HRT, mode of deliveries, weight,of heaviest baby,
PMH,
JAM THREADS + glaucoma,+, liver,+kidnesy
anti depressants, anti psychotics,
Previous PFMT, surgical treatment of SUI or POP
What are the main complaints for urinary incontinence
What are the main stress incontinence symptoms
What are the main urge incontinence symtoms
Urgency to void, increased day time frequency, nocturia, dysuria, haematuria,
cough and pee
suddenly need to pee
How is a patient with suspected incontinence assessed?
take a three day uriary diary, fluid intake of quality and quantity, urine output, daytime frequency, nocturia, avergae voided volume, (incontinence calender)
urine dipstick
What examinations are undertaken on a woman with suspected incontinence
Bladder/pelvic floor
abdominal
neurological
General examination
What signs and symptoms of incontinence are looked for on examination
prolapse stress incontinence uro-genital atrophy changes pelvic mass pelvic floor tone strength awareness
What investigations are carried out on a woman with suspected incontinence
Why does stress incontinence occur?
Urinalysis, multistix, MSSU.
post voiding residual volume assessment
urodynamics
Intraabdominal pressure exceeds urethral pressure resulting in leakage
