Incontinence

Question 1

Incontinence

Answer 1

involuntary loss of urine –> affects A LOT of people

• occurrence goes up with age
• related to anatomy/structure, neuro status, physical problems
• Gender, age, hormonal status, previous vaginal deliveries
• CT differences, neuro conditions, meds

Question 2

Normal Bladder Anatomy

Answer 2

Beta-adrenergic receptors in bladder dome
Alpha-1 receptors in trigone and urethral smooth muscle
Muscarinic receptors in deep layers throughout

Question 3

Urethral Sphincter

Answer 3

Internal -> smooth muscle, involuntary, alpha-1 receptors
External -> skeletal muscle, voluntary, pudendal nerve
Vessels assist in layers coming together to close urethra
Function affected by estrogen

Question 4

Autonomic Regulation of Bladder

Answer 4

• Sympathetics -> T10-L2 (inferior mesenteric plexus), hypogastric and pelvic nerves –> internal sphincter closing and bladder relaxation
• Somatics -> sacral cord alpha motor neurons in ventral horn –> external sphincter
• Parasympathetics -> sacral S2-4 –> bladder musculature

Question 5

Cholinergic Mechanisms

Answer 5

Detrusor muscle contracts when exposed to cholinergic agonists (activate M3 - contraction, activate M2 - inhibit relaxation)

Question 6

Adrenergic Mechanisms

Answer 6

Beta-adrenergic: B2 and B3 receptors (relaxation of detrusor)
Alpha-adrenergics: alpha-1A subtype in bladder base, urethra and blood vessels (agonist - increase urethral resistance, antagonist - block urethral contraction)

Question 7

Storage Reflex

Answer 7

Sympathetics activated by distention of bladder
- relax detrusor (beta-3)
- promote closure of urethral outlet (alpha-1)
Somatics activate by sudden increase in BP (cough)
- activates external urethral sphincter

Question 8

Micturition

Answer 8

Normal - somatic reflex -> fluid flow initiates bladder contraction by way of pudendal nerve and sacral spinal cord
Abnormal - spinal vesicovesical micturition reflex -> triggered by noxious stimuli resulting in bladder contraction

Question 9

Supraspinal Vesicovesical pathway

Answer 9

Parasympathetics

Complex -> located in pons -> triggered by stretch receptors in detrusor as bladder fills

Question 10

3 Main types of incontinence

Answer 10

1. Stress - leakage of small amounts or urine when intraabdominal pressure increases
2. Urge/detrusor overactivity/overactive bladder - leakage of large amounts of urine occuring shortly after sudden urge
3. Mixed - stress and urge incontinence occuring together

Question 11

Stress

Answer 11

muscles that normally keep urethra closed are prevented from squeezing as tightly as they should
- weakness, loss of elasticity, hormonal of CT issue

Question 12

Urge

Answer 12

inappropriate bladder contractions

- abnormal nerve signals

Question 13

Mixed

Answer 13

both stress and urge

Question 14

Overflow incontinence

Answer 14

caused by blockage of outlet or weak bladder muscle function (dribbling)

Question 15

Functional

Answer 15

untimely urination due to inability to get to bathroom

- mobility, obstacles, cognition

Question 16

Transient

Answer 16

temporary condition causing incontinence such as meds, infection, illness
D elirium
I nfection
A trophic vaginitis
P harmaceuticals
P sychological disorders
E xcessive urine output
R edduced mobility
S tool impaction

Question 17

Treatment for Stress Incontinence

Answer 17

weight loss if obese, fluid reduction, caffeine reduction, smoking cessation, control of constipation

• pelvic floor muscle exercises
• occlusive devices
• meds
• surgery

Question 18

Treatment for Urge Incontinence

Answer 18

bladder retraining
fluid restricition
eliminate meds/agents causing
pelvic floor muscle exercises