Female Urinary Incontinence

Question 1

S2, S3, S4

Answer 1

Keeps the penis off the floor

Allows to have micturition with voiding and emptying

Question 2

Pelvic nerves have ___ motor to detrusor

Answer 2

Parasympathetic control - allow you to empty

Question 3

Hypogastric nerve is ____ which allows for storage

Answer 3

Sympathetic

Question 4

Pudendal nerve is ___

Answer 4

Somatic sensory

Question 5

Which sphincter is responsible for continence?

Answer 5

The intrinsic sphincter (comprised of bladder neck muscle fibers)

Question 6

Which receptors in the bladder allow the bladder to expand? And the urethra to constrict?

Answer 6

Beta adrenergic in bladder allow expansion

Alpha adrenergic in urethra allow constriction

Question 7

what kind of muscle is the rhabdosphincter

Answer 7

Striated muscle

Question 8

Which 3 structures surround and support the bladder neck and urethra?

Answer 8

1. Arcus tendinous fasciae
2. Levator ani muscles
3. Endopelvic fascia

Question 9

For continence to be maintained, _____ pressure must be higher than ___ pressure.

Answer 9

Intraurethral pressure > Intravesical pressure

Question 10

NT involved in storage phase

Answer 10

NE and 5HT released - signals detrusor to relax and urethra to contract

Question 11

NT involved in the emptying phase

Answer 11

ACh release - signals detrusor to contract

Question 12

Definition of urinary incontinence

Answer 12

“The complaint of any involuntary leakage of urine”

Question 13

Stress incontinence

Answer 13

Complaint of involuntary leakage on effort or exertion or on sneezing or coughing

Most common type of women of all ages

Question 14

3 subcategories of stress incontinence

Answer 14

1. Urine loss occurring in the absence of urethral hypermobility
2. Urine loss due to urethral hypermobility (most common)
3. Urine loss due to intrinsic sphincter deficiency (lead pipe urethra)

Question 15

1 risk factor for stress incontinence

Answer 15

Vaginal delivery of a baby

Question 16

Urge incontinence

Answer 16

Complaint of involuntary leakage accompanied by or immediately preceded by urgency

Question 17

Pathophys of stress incontinence

Answer 17

Increased abdominal pressure –> Increased bladder pressure –> Urine leakage

Question 18

Urgency incontinence most commonly caused by?

Answer 18

Overactive bladder - involuntary bladder contraction

Subtypes:

• Neurogenic
• Myogenic
• Idiopathic

Question 19

Symptoms of stress incontinence

Answer 19

Cough, Sneeze, Laugh, Exercise, Change position

Question 20

Symptoms of urgency incontinence

Answer 20

Urgency, Frequency, Nocturia, Dysuria

Question 21

Urodynamic studies

Answer 21

Cystometry
Cough stress test
Multichannel urodynamics

Question 22

Multichannel urodynamics measures what?

Answer 22

P of detrusor

Question 23

Why do pelvic floor contraction exercises help reduce incontinence?

Answer 23

Levator Ani muscles:

• Maintains constant tone
• Rapid contraction with cough
• Relaxation with defecation/urination
• Massive expansion/stretching during labor with quick recovery to “normal”

Question 24

How many kegels do you need to do a day?

Answer 24

30

Question 25

3 muscles making up levator ani

Answer 25

• puborectalis
• pubococcygeus
• ileococcygeus

Question 26

Slow vs. Fast twitch levator ani muscles

Answer 26

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

Question 27

Tx of overactive bladder

Answer 27

Antimuscarinics are gold standard

Everything else is secondary

Question 28

Which muscarinic receptor do anticholinergics for OAB act upon?

Answer 28

M3 receptors

Question 29

1 complaint of someone on treatment for OAB

Answer 29

Dry mouth

Question 30

Who is oxybutinin contraindicated in?

Answer 30

Patients with glaucoma

Question 31

Which drug should you give to elderly to prevent confusion when treating OAB?

Answer 31

Trospium - Less CNS penetration