geriatrics: incontinence Flashcards
what does continence depend on
effective function of the bladder and integrity of the neural connections which bring it under voluntary control
- Bladder and Urethra
- Local Innervation
- CNS Connections
what muscles are involved in micturition and what innervation are they under?
detrusor and internal urethral sphincter is smooth muscle under control of parasympathetic nervous system
external urethral sphincter is striated muscle (only bit we have control over)
describe urine storage
sympathetic system, hypogastric nerve
- detrusor muscle relaxation (b adrenoreceptors, T10 - L2)
- filling to normal volume
- internal urethral sphincter contraction (a adrenoreceptors, T10 - S2)
- external urethral sphincter contraction (pudendal nerve, S2 - S4)
describe voluntary voiding
parasympathetic system, pelvic nerve (S2 - S4)
- contraction of bladder (pelvic nerve, S2 - S4)
- relaxation of internal sphincter (pelvic nerve, S2 - S4)
- voluntary relaxation of external sphincter (pudendal nerve, S2 - S4)
describe the CNS connections involved
pontine micturition centre normally exerts a “storage program” of neural connections until a voluntary switch to a voiding program occurs.
- centres within CNS inhibit parasympathetic tone
- promoting bladder relaxation and storage of urine
what is the capacity of the bladder?
holds 500ml, at 250ml start to feel it then at 400ml becomes urgent
describe the aetiology of incontinence?
problem with bladder or urinary output
too strong or too weak
what are the different kinds of urinary incontinence?
- stress incontinence
- urinary retention with overflow incontinence
- urge incontinence
- neuropathic bladder
describe stress incontinence
bladder outlet too weak
- urine leak on movement, coughing, laughing, squatting
- weak pelvic floor muscles
- common: parity, post-menopausal
treatment: physiotherapy, oestrogen cream, duloxetine, surgery (TVT/colposuspension)
describe urinary retention with overflow incontinence
bladder outlet “too strong”
- poor urine flow, double voiding, hesitancy
- blockage to urethra
- older men with BPH
treatment: alpha blocker, anti-androgen, surgery (TURP)
what are the effects of alpha-blockers on the urinary tract?
drugs – tamsulosin
effect - Relaxes sphincter
what are the effects of anti-androgen?
drug - finasteride
effect – shrinks prostate
describe urge incontinence
bladder muscle too strong
- detrusor contracts at low volumes
- sudden urge to pass urine immediately
treatment: anti-muscarinics (oxybutinin, tolterodine, solifenacin), bladder re-training
what are the effects of anti-muscurinics?
drugs – oxybutynin, tolterodine, solifenacin
effect – relax detrusor
describe neuropathic bladder
rare
no awareness of bladder filling → overflow incontinence
secondary to neurological disease (MS or stroke) or prolonged catheterisation
treatment: catheterisation, parasympathomimetics may help
