female urology - urinary incontinence Flashcards
what are the main functions of the lower urinary tract ?
- preservation of the upper tracts by low pressure storage of urine with continence and low pressure voiding to completion
- storage
- voiding
how does storage of urine happen ?
by bladder relaxation
sphincter contraction
how does voiding of urine happen ?
by bladder contraction
sphincter relaxation
how does the filling phase occur ?
- the bladder distends without rise in the intra-vesicle pressure
- the sphincter unit contracts and closes the urethra
how does the voiding phase happen ?
- the bladder contracts and expels the urine
2. the sphincter unit relaxes and urethra opens
which neural pathway is responsible for the filling phase?
sympathetic pathway
which neural pathways responsible for the voiding phase?
parasympathetic pathway
how does the sympathetic pathway work to allow for urine filling ?
noradrenaline works on b3 receptors which then allows for the relaxation of the detrusor muscle and the contraction of the urethral sphincter
how does the parasympathetic pathway work to allow for the voiding of urine ?
acetylcholine works on muscarinic (M3) receptors and allows for the contraction of the detrusor muscle and the relaxation of the urethral sphincter
what is the basic mechanism of urine incontinence ?
inappropriate bladder contraction
or
inappropriate sphincter relaxation
if there is a problem with the sphincter function what is this type of incontinence called ?
stress incontinence
if there is a problem with the bladder contraction what type of incontinence is this ?
urge incontinence
what are the possible causes of urge incontinence ?
neurogenic
Multiple sclerosis
idiopathic
bladder pathology
what are the possible causes of stress incontinence ?
- weakness of pelvic floor as with women who have gone through multiple vaginal births
- trauma - prostate surgery
- neurological
or involuntary leakage on effort such as with sneezing or laughing
what does the abbreviation DIAPPERS stand for in history taking of urinary symptoms ?
delerium diuretics infection atrophy pharma psychological excess UO restricted mobility stool impaction
how can stool impaction cause urinary incontinence ?
When hardened feces accumulates in the rectum, this can cause the anal sphincters to relax and allow liquid stool to escape around the blockage
what examinations can be performed for a patient complaining of urinary symptoms ?
full bladder test - cystometric test
cough/valsalva
manual dexterity
if a patient was to come complaining of urge incontinence what should the initial management be ?
- behavioural therapy
( weight control, fluid control, caffeine intake) - continence advise
( training of pelvic floor muscles, bladder retaining) - pharmacotherapy
what is the main goal of pharmacotherapy ?
achieve bladder relaxation
what are the different types pf pharmaceutical drugs used to achieve bladder relaxation ?
b3 agonists M3 antagonists ( anti-muscarinic , anticholinergic)
what kind of anti muscarinic drugs are used ?
tertiary amines such as : solifenacin tolterodine or quaternary amines oxybutynin tricyclic antidepressants
if the first line of treatment did not work what can be dpone ?
consider changing the type of anti-muscarinic
higher dose
combination treatment
mirabegron
what can be used for overactive bladder syndrome ?
mirabegron
what further management can be done in cases of urge incontinence in the failure of the pharmaceutical approach ?
Botox PTNS (percutaneous tibial nerve stimulation) neuromodulation bladder augmentation diversion
