GYN- Incontinence

Question 1

Descibe the innv needed for continence

Answer 1

INVOLUNTARY
sympatetic: via hypogastric N –> detrusser relaxation + internal sphincter constriction (HOLDS PEE)

Parasympathetic: via pelvic splanchnic N –> MAch R –> detrussor contraction and internal sphincter relaxation (EXPELS PEE)

VOLUNTARY:::
SOMATIC CONTROL of external anal sphincter via pudental N

Question 2

First step when pt comes in for incontinence

Answer 2

get UA/UCx to r/o UTI

Question 3

urine leakage with exertion or straining =

Tx?

Answer 3

stress incontinence

surg to stabalize hypermobile urethra (best) > kegek, pessaries

Question 4

urine leakage due to detrussor overactivity/involuntary bladder contractions

Tx?

Answer 4

urge incontience

anti-cholinergics (oxybutinin)
TCAs (imipramine)

Question 5

urine leakage with urine retantion and over distention

Tx?

Answer 5

overflow incontinence`

intermittent self cath 
cholinergics (inc bladder contractility)
a1 blockers (inc urethral resistance)

Question 6

urine leakage due to fistula following pelvic surgery or pelvic radiation

Answer 6

bypass incontinence

Question 7

urine leakage due to physcial or psych issues, common in nursing homes

Answer 7

functional incontinence

Question 8

old age causes what kind of incontinence

Answer 8

stress and functionlal

Question 9

UTIs cause what kind of incontinence

Answer 9

urge (detrussor overactivity/involuntary bladder contractions)

Question 10

bladder stones or cancer cause what kind of incontinence

Answer 10

urge (detrussor overactivity/involuntary bladder contractions)

Question 11

how to diagnose bypass incontinence

Answer 11

methylene blue or indigo carmine dye