Incontinence

Question 1

3 types of Stress Incontinence

Answer 1

Type 1: Urine loss occurring in the ABSENCE of urethral hypermobility

Type 2: urine loss due to urethral hypermobility
- most common

Type 3: Urine loss due to intrinsic sphincter deficiency

Question 2

Urge incontinence

• what is it?
• what is it most commonly caused by?

Answer 2

Involuntary leakage accompanied by or immediately preceded by urgency
- most commonly caused by overactive bladder syndrome

*stress incont is mostly caused by urethral hypermobility

Question 3

Mixed incontinence

Answer 3

involuntary leakage associated with urgency and ALSO with exertion, effort, sneezing or coughing

*stress incontinence + urge incontinence

Question 4

Most common cause of stress incontinence

Answer 4

urethral hypermobility
- results from poor urethral support

*urge incont. is most commonly caused by overactive bladder synd.

Question 5

Intrinsic sphincter deficiency (stress incontinence) is usually result of?

Answer 5

deterioration of urethral musculature (external urethral sphincter) and/or neurologic injury
- urethra fails to close in response to increases in intra-abdominal pressure

Question 6

Type of female incontinence:
Cough
Sneeze
Laugh
Exercise
Position change

Answer 6

Stress Inc

Question 7

Type of female incontinence:
Urgency
Frequency
Nocturia
Dysuria

Answer 7

Urgency Inc.

Question 8

Type of female incontinence:

Stress + urge

Answer 8

Mixed

Question 9

Cystometry

Answer 9

Detects rise in bladder P and the sensations that occur when the bladder fills
- Pt is standing –>
insert catheter –>
empty bladder –>
500 cc of water –>
Ask pt to report bladder initial sensation, initial urge to void, and maximum bladder capacity.

• Not very sensitive. Miss 40%.

Question 10

3 muscles that make up Levator ani

Answer 10

PPI
Puborectalis
Pubococcygeus
Iliococcygeus

Question 11

What indicates detrusor muscle overactivity in cystometry

Answer 11

Any rise in the meniscus of the fluid in the barrel of the syringe is considered a detrusor contraction and indicates detrusor overactivity.1

Question 12

Multichannel urodynamics

Answer 12

Measures physiologic fxns of lower urinary tract

• P catheter in bladder and vagina or rectum
• Pdet calculated

Question 13

4 fxns of levator Ani muscles

Answer 13

1. Maintains constant tone
2. Rapid contraction w/ cough
3. Relaxation w/ defecation/urination
4. Massive expansion/stretching during labor with quick recovery to “nl”

Question 14

Type I fibers vs Type II

Answer 14

Type I fibers:

• slow twitch
• maintain tone
• 70% of muscle

Type II fibers:

• fast twitch
• rapid response to sudden increases in P
• 30% of muscle

Question 15

Sensations of bladder fullness begin when the bladder is at half its physiologic capacity which is _____ mL. Max cystometric capacity is achieved at _____ mL.

Answer 15

First sensation: 100 mL

First desire to void:
250 mL

Max capacity:
500 mL

Question 16

Muscle action when a person chooses to void. What about when it is complete?

Answer 16

the
urethral sphincter is voluntarily relaxed, the pelvic floor relaxes,
the detrusor contracts, and micturition occurs.

Once complete, the cycle resumes with bladder filling. The urethral sphincter and pelvic floor contract while the detrusor relaxes.

Question 17

Urinary incontinence affects what % of women?

Answer 17

15-50%

*increases in prevalence with age

Question 18

Parasympathetic nerve stimulation and administration of cholinergic drugs cause the detrusor muscles to ____

Answer 18

contract

Question 19

Anticholinergic drugs cause the detrusor muscle to:

Answer 19

relax

- reduce bladder P and increase bladder capacity

Question 20

Parasympathetic fibers originate in ____.

Sympathetic fibers originate from ____.

Answer 20

PS:
sacral spinal chord seg S2-S4

S:
Thoracolumbar segments (T10-L2)
- has alpha and beta adrenergic components

Question 21

Alpha and beta fibers of the sympathetic system terminate where?
What does stimulation to each do?

Answer 21

B: terminate in detrusor muscle

• stimulation relaxes urethra and detrusor muscle
• let bladder fill up

a: terminate in urethra
- stimulation contracts the bladder neck and urethra
- relaxes detrusor
* not let anything out

Question 22

Pudendal nerve (S2-4) provides motor innervation to ____

Answer 22

Striated urethral sphincter

Question 23

Secondary defense against incontinence

Answer 23

Striated muscular urethral sphincter, which surrounds the distal 2/3s of the urethra

• contributes 50% of total urethral resistance
• also responsible 4 interruption of urinary flow at end of micturition

Question 24

Most common vaginal prolapse

Answer 24

cystocele

- anterior vagina

Question 25

First line therapy to improve/cure mild-mod forms of stress urinary incontinence.
Severe SUI?

Answer 25

Pelvic floor muscle exercises aka kegals
- cotract levator ani muscles –> increases urethral tone

Severe: surgery is most common tx

Question 26

Estrogen FX on urethra

Answer 26

Urethra has E receptors.

- w/o E urethra atrophies and opens wider.

Question 27

Muscarinic receptors are found in CNS and bladder. Stimulating M2 and M3 receptor subtypes in bladder will cause ________

Answer 27

detrusor contraction

- so blocking these receptors facilitates bladder storage via SM relaxation

Question 28

Mainstay of tx for overactive bladder

Answer 28

Oxybutynin chloride (ditropan)

• a sm relaxant
• Muscarinic receptor antag

Tolterodine (detrol)
- musc r antag

Question 29

NT role in storage phage

Answer 29

NE and 5HT released
–>
Signals detrusor to relax and urethra to contract

Question 30

NT role in emptying phase

Answer 30

ACh released
–>
Signals detrusor to contract