Incontinence

Question 1

Two most important muscles for pelvic floor support?

Answer 1

Levator Ani

Bulbcarvernosus

Question 2

Receptors found in the bladder dome

Answer 2

Beta adrenergic
Sympathetic innervation = storage
Responsible for filling/relaxation of the dome

Question 3

Receptors found in trigone and urethral smooth muscle

Answer 3

Alpha 1
Trigone - forms the internal sphincter
Sympathetic innervation = storage
Responsible for tightening the sphincter

Question 4

Receptors found through out the deep layer of the bladder?

Answer 4

Muscarinic receptors
Parasympathetic = Contract and empty
“Rest and digest”

Question 5

What part of the urinary tract is under voluntary control?

Answer 5

External urethral sphincter

Question 6

How does estrogen affect the internal sphincter of the urethra?

Answer 6

Vessels circumferentially line urethra, and come together to close urethra

This is less vascular with decreased levels of estrogen (allowing leakage)

Question 7

What types of muscarinic receptors are found in the bladder smooth muscle?

Answer 7

M3 - smooth muscle contraction

M2 - Inhibits bladder relaxation

Question 8

What nerve is responsible for voluntary urinary sphincter control?

Answer 8

Pudendal nerve

Question 9

What are the 3 main types of incontinence?

Answer 9

Stress
Urge/Overactive Bladder
Mixed

Question 10

Leakage of small amounts of urine when intraabdominal pressure is increased

Answer 10

Stress Incontinence

Question 11

Leakage of large amounts of urine occuring shortly after a sudden urge to urinate mediated by bladder muscle contractions

Answer 11

Urge/Detrusor Overactivity/Overactive bladder

Question 12

What is mixed incontinence?

Answer 12

Stress and urge incontinence occurring together

Question 13

Incontinence while coughing, laughing, can usually predict when it is going to happen

Answer 13

Stress incontinence

Question 14

Incontinence occurring after a sudden urge

Answer 14

Urge incontinence/ overactive bladder

Detrusor overactivity, or inability to suppress detrusor contractions

Question 15

Describe the pathophysiology of stress incontinence… what can cause it?

Answer 15

Muscles that normally keep the urethra close are prevented from squeezing as tightly as they should:

pelvic floor weakness
Loss elasticity
Hormonal or connective tissue effects on sphincter

Question 16

Overflow incontinence

Answer 16

Caused by either a blockage of the outlet (prostate enlargemet) or weak bladder muscle functions

Results in frequent or constant dribbling

Question 17

Functional incontinence

Answer 17

Untimely urination due to inability to get to a bathroom either from mobility issues, obstacles, communiation/cognitive problems

Question 18

Transient incontinence

Answer 18

Temporary condition causing incontinence such as medication, infection, illness

Question 19

What things can cause transient incontinence?

Answer 19

DIAPPERS

Delirium
Infection
Atrophic vaginitis
Pharmaceuticals
Psychological disorder
Excessive urine output
Reduced mobility
Stool impaction

Question 20

Sometimes medications used to treat incontinence (anticholinergics, beta agonists, alpha agonists) may cause what type of incontinence?

Answer 20

Overflow incontinence
Constant dribbling
Don’t fully empty because of detrusor weakness

Question 21

What lifestyle changes can be made to treat incontinence?

Answer 21

Wt loss
Fluid reduction
Less caffeine
Smoking cessation

Question 22

List some non-pharmacological treatments of incontinence

Answer 22

Lifestyle modifications
Kegel exercises
Pessary

Question 23

How does intravaginal estrogen help with urinary incontinence?

Answer 23

Estrogen thickens the periurethral tissue by increasing vascular engorgement

Question 24

Medications are more commonly used to treat which type of incontinence?

Answer 24

Urge incontinence! Use anticholinergics

Question 25

What medications can be used to treat urge incontinence?

Answer 25

Anticholinergics
B-agonists
Estrogen
Botulinum toxin injections

Question 26

For incontinence, do you want to prescribe vaginal estrogen, or systemic?

Answer 26

VAGINAL! Systemic makes it worse

Question 27

Main symptom of pelvic organ prolapse?

Answer 27

Most are asymptomatic!