Female Urinary Incontinence Flashcards
S2, S3, S4
Keeps the penis off the floor
Allows to have micturition with voiding and emptying
Pelvic nerves have ___ motor to detrusor
Parasympathetic control - allow you to empty
Hypogastric nerve is ____ which allows for storage
Sympathetic
Pudendal nerve is ___
Somatic sensory
Which sphincter is responsible for continence?
The intrinsic sphincter (comprised of bladder neck muscle fibers)
Which receptors in the bladder allow the bladder to expand? And the urethra to constrict?
Beta adrenergic in bladder allow expansion
Alpha adrenergic in urethra allow constriction
what kind of muscle is the rhabdosphincter
Striated muscle
Which 3 structures surround and support the bladder neck and urethra?
- Arcus tendinous fasciae
- Levator ani muscles
- Endopelvic fascia
For continence to be maintained, _____ pressure must be higher than ___ pressure.
Intraurethral pressure > Intravesical pressure
NT involved in storage phase
NE and 5HT released - signals detrusor to relax and urethra to contract
NT involved in the emptying phase
ACh release - signals detrusor to contract
Definition of urinary incontinence
“The complaint of any involuntary leakage of urine”
Stress incontinence
Complaint of involuntary leakage on effort or exertion or on sneezing or coughing
Most common type of women of all ages
3 subcategories of stress incontinence
- Urine loss occurring in the absence of urethral hypermobility
- Urine loss due to urethral hypermobility (most common)
- Urine loss due to intrinsic sphincter deficiency (lead pipe urethra)
1 risk factor for stress incontinence
Vaginal delivery of a baby
Urge incontinence
Complaint of involuntary leakage accompanied by or immediately preceded by urgency
Pathophys of stress incontinence
Increased abdominal pressure –> Increased bladder pressure –> Urine leakage
Urgency incontinence most commonly caused by?
Overactive bladder - involuntary bladder contraction
Subtypes:
- Neurogenic
- Myogenic
- Idiopathic
Symptoms of stress incontinence
Cough, Sneeze, Laugh, Exercise, Change position
Symptoms of urgency incontinence
Urgency, Frequency, Nocturia, Dysuria
Urodynamic studies
Cystometry
Cough stress test
Multichannel urodynamics
Multichannel urodynamics measures what?
P of detrusor
Why do pelvic floor contraction exercises help reduce incontinence?
Levator Ani muscles:
- Maintains constant tone
- Rapid contraction with cough
- Relaxation with defecation/urination
- Massive expansion/stretching during labor with quick recovery to “normal”
How many kegels do you need to do a day?
30
3 muscles making up levator ani
- puborectalis
- pubococcygeus
- ileococcygeus
Slow vs. Fast twitch levator ani muscles
Type I - slow twitch
- maintain tone
- 70% of the muscle
Type II - fast twitch
- rapid response to sudden increases in pressure
- 30 % of the muscle
Tx of overactive bladder
Antimuscarinics are gold standard
Everything else is secondary
Which muscarinic receptor do anticholinergics for OAB act upon?
M3 receptors
1 complaint of someone on treatment for OAB
Dry mouth
Who is oxybutinin contraindicated in?
Patients with glaucoma
Which drug should you give to elderly to prevent confusion when treating OAB?
Trospium - Less CNS penetration
