female urinary incontinence Flashcards
What structure is responsible for continenc
The intrinsic sphincter, comprised of bladder neck muscle fibers and the mid-urethral complex(smooth muscle)
know the locations of the following: bladder neck sphincter, mid-urethra complex, external rhabdosphincter, detrusor muscle,
ok
what structures make up the external urethral sphincter
rhabdosphincter plus the striated muscle surrounding the urethra
Which structures support the bladder neck and urethra
the arcus tendinous fasciae pelvis, the levator ani muscles, and the endopelvic fascia
peripheral innervation of lower urinary tract
the sacral parasympathetic (pelvic nerve); the thoracolumbar sympathetic (hypogastric nerve); and the sacral somatic (pudendal nerve)
mechanism of urine storage phase
bladder fills > beta-adrenergic receptors in bladder send message via PSNS (pelvic nerve) to sacral spinal cord > pudendal nerve signals external urethral sphincter to constrict > hypogastric nerve signals detrusor to relax and expand, and internal urethral sphincter to constrict.
Guarding reflex
As the bladder fills, the external urethral sphincter increases its contractions in an action known as the guarding reflex. This also prevents urine loss during coughing, sneezing, etc.
mechanism of urine emptying phase
Pelvic nerve sends message to sacral spinal cord > pontine micturition center > cerebral cortex (voluntary control center) > sends signal to hypogastric nerve to cause detrusor muscle contraction and sends signal to pudendal nerve to cause levator ani relaxation, internal and external sphincter opening
which neurotransmitters are involved in storage and emptying phases of urination?
Urethral smooth muscle has alpha-adrenergic receptors and detrusor muscle has beta adrenergic receptors plus muscarinic receptors. Storage: norepinephrine and serotonin cause detrusor relaxation and urethral contraction. Emptying: acetylcholine released causes detrusor contraction
- List and define the categories of urinary incontinence.
- stress incontinence: the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing. 2. Urge incontinence: the complaint of involuntary leakage accompanied by or immediately preceded by urgency. 3. Mixed incontinence: of involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing. 4. overflow incontinence: urinary retention from hypotonic bladder. 5. Genitourinary fistulase
Subcategories of stress incontinence
type 1: urine loss occuring in absence of urethral hypermobility. Type 2: urine loss due to urethral hypermobility. Type 3: urine loss due to intrinsic sphincter deficiency
What causes urge incontinence
Sudden, involuntary bladder contractions. Most are idiopathic (idiopathic detrusor overactivity) but some have identifiable causes like inflammation, infection, parkinsons (neurogenic), myogenic
stress incontinence pathophys
Urethral hypermobility and/or intrinsic sphincter deficiency
urge incontinence Sx
urgency (with or without incontinence), frequency (defined as the patient complaint of voiding too often during the day), and nocturnal enuresis (defined as awakening 1 or more times at night to void) and dysuria. More than one symptom must be present
methods to evaluate urinary incontinence
- cystometry: detects rises in bladder pressure and the sensations that occur when the bladder fills. Low sensitivity but improves reliability of cough stress test due to a known bladder volume. 2. cough stress test. 3. multichannel urodynamics: Pressure catheter in bladder and vagina or rectum
- cystometry: detects rises in bladder pressure and the sensations that occur when the bladder fills. Low sensitivity but improves reliability of cough stress test due to a known bladder volume. 2. cough stress test. 3. multichannel urodynamics: Pressure catheter in bladder and vagina or rectum
levator ani functions
contain 70% type I (slow-twitch) fibers to maintain constant tone and30% type II (fast-twitch) fibers to provide reflex and voluntary contractions.
maximum capacity of the bladder, volume of first sensation of bladder fullness, volume at desire to void
max capacity: 500ml. First sensation: 100cc. Desire to void: 250ml
What is the mainstay of medical treatment for ovaractive bladder
Anticholinergic drugs
how to anticholinergic drugs work in OAB
muscarinic receptors M2 and M3 predominate in the bladder, with M3 responsible for contraction. Blocking these receptors reduces activity of bladder
Anticholinergic side effects
Memory loss (M1 block), tachycardia (M2 block), constipation (M3 block), dry mouth, blurred vision and drowsiness (all M3 block)
List antispasmodics used for OAB
oxybutynin: smooth muscle relaxant. Tolterodine: muscarinic antagonist. Trospium: antimuscarinic
alpha and beta adrenergic innervation of the bladder/urethra
alpha adrenergic stimulation contracts the bladder neck and urethra and relaxes the detrusor. beta-Adrenergic stimulation relaxes the urethra and detrusor muscle
list other medical treatments for urinary incontinence
estrogens (used if urethral atrophy is the problem), tricyclic antidepressants (anticholinergic properties improve compliance and increases bladder outlet resistance)