Incontinence Flashcards
when are the two peaks when people are most likely to experience incontinence?
- after menopause
- in old age
what are the extrinsic causes of incontience?
- reduced mobility
- confusion
- drinking too much @ wrong time
- medications (diuretics)
- constipation
- home and social circumstances
what do the drugs for incontinence target?
The autonomic nervous system - wide range of side effects.
how is the detrusor muscle supplied?
smooth muscle
how is the internal urethral sphincter innervated?
smooth muscle - ANS
how is the external urethral sphincter innervated?
skeletal muscle
what does the parasympathetic nerves do to the bladder and urethra?
Bladder - contracts it
internal urethral sphincter - relaxes it
what does the sympathetic nerves do to the bladder and urethral sphincter?
Relax detrusor muscle
contract internal urethral sphincter
how much urine does the bladder usually hold?
400-600mls
at what volume do you get an awareness that your bladder is filling?
250mls.
how much urine is normal to be left over after voiding?
up to 100mls
anything over 250mls is abnormal
what is the normal tone of the bladder?
there is permanent inhibitory tone which goes down to the bladder telling it to relax
what happens to CNS and bladder when you lose consciousness?
the permanent inhibition of ladder contraction is lost so bladder contracts causing voiding.
which part of the brain are involved in storage of urine?
pons micturition centre
frontal cortex
caudal part of spine
what are the 4 intrinsic factors affecting incontinence?
- bladder too strong
- bladder too weak
- outlet too strong
- outlet too weak
what is stress incontinence?
when bladder outlet is too weak
- urine leak on movement, coughing, laughing.
who commonly gets stress incontinene?
post menopausal women (loss of oestrogen that strengthens muscles)
after giving birth
what is the treatment for stress incontinence?
Mainly physiotherapy - Kegel exercise, vaginal cones, pelvic floor stimulators
oestrogen cream
duloxetine
colposuspension
what is urinary retention with overflow incontinence?
bladder outlet too strong
- poor urine flow, double voiding, hesitancy, post micturition dribbling.
who commonly gets urinary retention with overflow incontinence?
older men - BPH
how is urinary retention treated?
alpha blocker - tamsulosin (relieves sphincter)
anti-androgen - finasteride (shrinks prostate)
surgery - TURP
catheterisation - often suprapubic
Exercises don’t tend to work for this sort of incontinence
what is urge incontinence?
the bladder muscle is too strong
detrusor muscle contracts when not full, sudden urge immediately, caused by bladder stones or stroke
how is urge incontinence treated?
anti muscarinics/cholinergics - target cholinergic receptors and block them to relax detrusor muscle.
oxybitinin
tolterodine
solifenacin
what drugs relax the detrusor muscle?
antimuscarinics - oxybutin, tolterodine, solifenacin, trospium
Beta-3 adrenoreceptor agonists - mirabegron
which drugs shrink the prostate?
anti-androgens - finasteride, dutasteride
which drugs relax the sphincter and bladder neck?
alpha blockers - tamsulosin, terazosin, indoramin
which drugs relax the sphincter and bladder neck?
alpha blockers - tamsulosin, terazosin, indoramin
what is neuropathic bladder?
underative bladder
secondary to neurological disease - multiple sclerosis and stroke
catheter is most common cause and treatment
RESULTS IN OVERFLOW INCONTINENCE.
when should someone be referred to a specialist?
if initial management (3 months of non pharmacological treatment + medication) doesn’t work
when is referral to a specialist needed straight away?
vesico-vaginal fistula
palpable bladder after voiding
faecal incontinence
what are the last resorts for treatment?
pads urosheats intermittent catherisation (better) catheterisation - worse suprapubic catheter
