incontinence Flashcards
What are some extrinsic factors which can cause incontinence
Reduced mobility
Confusion
Drinking too much at the wrong time
Diuretics
Constipation
Home and Social circumstances
What is the function of the bladder
Urine storage or voluntary voiding
What kind of muscles are the muscles of the bladder
Detrusor - smooth muscle
Internal urethral sphincter - smooth muscle
External urethral sphincter - striated muscle
What nerves innervate the detrusor muscle
T10-L2 sympathetic - cause the detrusor muscle to relax
What nerves cause contraction of the neck of the bladder and internal urethral sphincter
T10-S2 sympathetic
What increases strength and frequency of contractions of the neck of the bladder
S2-4 parasympathetic
What causes contraction of the pelvic floor muscles and the external urethral sphincter
S2-S4 somatic - pudendal nerve
What is stress incontinence and the presentation
Bladder outlet too weak
- Urine leak during movement such as laughing and coughing
- Weak pelvic floor muscles
- Common in women after birth, especially after menopause
What is the treatment of stress incontinence
Physiotherapy
Oestrogen cream
Duloxetine
What kind of exercises strengthen the pelvic floor
Kegel exercises
Vaginal cone
Pelvic muscle stimulater
What is the presentation of urinary retention with flow overflow incontinence
Bladder outlet is too strong
- Poor urine flow
- Hesitancy
- Post-micturition dribbling
- Double voiding - needing to urinate soon after already urinating
- BPH - benign prostatic hyperpasia
What is the treatment for urinary retention with overflow incontinence due to BPH
Alpha blocker such as tamsulosin which relaxes the internal urethral sphincter or ant-androgen such as finasteride which shrinks the prostate
TURP - Trans urethral resection of prostate could also be done
What is the presentation of urge incontinence
Bladder to strong
- detrusor contracts at lower volumes
- Sudden urge to urinate
- Can be caused by bladder stones
What is the treatment of urge incontinence
Antimuscarinics which relax the detrusor muscle - oxybutinin or tolteroine
What is the presentation of neuropathic bladder
Underactive bladder
- secondary to neurological disease such as a stroke or ms
- Secondary to prolonged catheterisation
- No awareness of the bladder filling so they have overflow incontinence
