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Genitourinary > Incontinence > Flashcards

Incontinence Flashcards

1
Q

What is urinary incontinence?

A

Unintentional passing of urine

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2
Q

What are the consequences of urinary incontinence?

A 
Hygiene problems
Skin damage
Socially restricting
Affects self-esteem
Reduces quality of life
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3
Q

Why are women more often affected by urinary incontinence?

A

Because they are often affected weakening of pelvic floor and sphincter muscles due to childbirth

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4
Q

What are the risk factors of urinary incontinence?

A 
Multiparity
Hysterectomy
Obesity
Bowel dysfunction
Menopause
Dietary factors: caffeine, alcohol
Drugs: diuretics
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5
Q

What is the muscle found in the wall of the bladder?

A

Detrusor muscle

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6
Q

Which type of muscle makes up the:

  • internal urethral sphincter
  • external urethral sphincter?
A

Internal: smooth

External: skeletal

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7
Q

Which branch of the nervous system controls micturition?

A

Autonomic: parasympathetic + sympathetic

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8
Q

What is the role of the parasympathetic nerves in micturition?

What neurotransmitters do they use?

A

Drive detrusor contraction
So drives urination

Cholinergic

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9
Q

What is the role of the sympathetic nerves in micturition?

What neurotransmitters do they use?

A

Inhibits contraction of detrusor
So prevents urination

Noradrenergic

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10
Q

What types of incontinence are there? Briefly say what they are.

A

Stress: sphincter weakness

Urge: overactive bladder

Mixed stress + urge

Overflow

Functional

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11
Q

What is stress incontinence?

A

Sphincter weakness that causes small leakages of urine when intra-abdominal pressure rises

This happens when laughing, coughing, exercising

The urethra becomes hypermobile

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12
Q

What causes stress incontinence?

A

Primary:

  • neurogenic problems
  • congenital (rare)

Secondary:
- pelvic floor damage to nerves + fascial support

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13
Q

What is meant by the urethra becoming ‘hypermobile’?

A

When the urethra sags and ends up below the pelvic floor, meaning the sphincters are unable to control urine outflow

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14
Q

Management of stress incontinence?

A

Reduce caffeine and alcohol intake

Pelvic floor re-education + physio

Duloxetine: a drug that is not great

Surgical methods

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15
Q

What type of drug is duloxetine?

A

A serotonin-noradrenaline reuptake inhibitor

Treats stress incontinence

Many side effects and not much benefit

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16
Q

What surgical methods can be used to treat stress incontinence?

A

A sling:

  • a hammock underneath the urethra to provide support and prevent hypermobility
  • TOT and TVT slings

Colposuspension:
- stitches to support bladder neck

Injectable drugs:
- to make bladder neck stronger

Artificial urinary sphincter

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17
Q

What are TOT and TVT slings?

What is meant by autologous in this context?

A

Used to treat stress incontinence

TOT: Trans-obturator tape sling

TVT: tension-free vaginal tape sling

Autologous = when the tape is made out of the person’s own tissue

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18
Q

Describe an artificial urinary sphincter?

A

A cuff fits around the urethra and can be inflated to close off the urethra

The cuff is inflated with fluid stored in a balloon placed under the abdominal muscles

The pump is placed in the scrotum for men and in the lower abdominal muscles for women

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19
Q

What is urge incontinence?

What are the features of it?

A

Urgent need to void and sometimes urine leakage or complete emptying of bladder before you can get to a toilet

Enuresis: bed wetting
Incontinence with the sound of running water

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20
Q

What causes urge incontinence?

A

Detrusor muscle over-activity due to:

  • detrusor instability
  • brain damage

Overactive bladder

Vaginitis, urethritis

UTI

21
Q

What is detrusor instability and what causes it?

A

Detrusor muscle contracts when it shouldn’t

Local irritation of the bladder such as infection, trauma, inflammation

22
Q

What types of brain damage causes detrusor instability?

A

Dementia
Stroke
Parkinson’s

23
Q

Investigation of urge incontinence?

A

Ultrasound of bladder to exclude urinary retention

24
Q

Management of urge incontinence?

A

Treat cause if able to: i.e. infection

Behavioural therapy:

  • limit fluid intake
  • mind over bladder

Pelvic floor exercises
Electrical stimulation

Drugs

Botox

Bladder augmentation

25
Q

What drugs are used to treat urge incontinence?

A

Anti-cholinergic agents:
- oxybutynin

Beta-3-agonist: mirabegron

26
Q

How do anti-cholinergic agents work to treat urge incontinence?

A

Because the parasympathetic nervous system, which drives detrusor contraction, are cholinergic

Anti-cholinergic drugs prevent excessive and unwanted contraction of detrusor muscle

27
Q

Describe how Botox is used to treat urge incontinence?

What are the risks?

A

Botox is a neurotoxin that paralyses muscles

Inject into bladder to paralyse it

Sometimes paralysis of bladder can cause retention of urine, because muscles don’t expel urine

28
Q

What is bladder augmentation?

A

Two types:

Detrusor myectomy: removing part or all of the muscle layer surrounding the bladder

Cystoplasty: insert a patch of small bowel into the bladder wall

Both of these treatments aim to prevent the bladder contracting as forcefully

29
Q

What is overflow incontinence?

A

When the bladder is unable to void completely so urine builds up causing the bladder to be overfilled

Overfilling leads to leakage of urine

30
Q

What causes overflow incontinence?

A

Obstruction of urine outflow:

  • stricture
  • enlarged prostate
  • stones

Detrusor weakness

  • MS
  • cauda equina damage
31
Q

Are males or females more commonly affected by overflow incontinence?

A

Males, because they get obstruction more by things like stones, prostate enlargement

32
Q

Management of overflow incontinence?

A

Treat whatever is causing the obstruction

Otherwise, catheterisation

33
Q

What is functional incontinence?

A

The person is aware of the need to urinate, but for physical or mental reasons they are unable to get to a toilet

34
Q

How can you treat functional incontinence?

A

Use of a commode, or pads

Ease of access to toilet

35
Q

In spastic spinal cord injuries, what is the effect on the bladder?

A

Still have bladder contraction reflexes

So the bladder contracts involuntarily

Causing voiding at inappropriate times

36
Q

In flaccid spinal cord injuries, what is the effect on the bladder?

A

No bladder reflexes

Bladder fills until it overflows

Causing overflow and stress incontinence

37
Q

What is the difference between a flaccid and spastic spinal cord injury (briefly, in terms of reflexes)?

A

Spastic = you still have reflexes but they are not from the brain

Flaccid = reflexes are lost

38
Q

What is an ‘unsafe bladder’?

A

One that puts kidneys at risk, for example a reflux of urine into the kidneys

39
Q

What two options do you have to treat a person who incontinent as a result of a spastic spinal cord injury?

A

They will have a reflex bladder

So you can either:

  1. Harness the reflexes and collect the urine using a catheter bag or penile sheath
  2. Supress the reflexes and make it areflexic, empty regularly with a catheter
40
Q

What is a penile sheath?

A

A condom-like sheath that fits over the penis ad collects the urine in a bag attached to the leg

41
Q

What type of patients are best suited to penile sheaths?

A

Men with urge or stress incontinence, uncontrolled leakage of urine

Men with good mental ability and dexterity
Men with no damaged skin on the penis

42
Q

What are the problems that penile sheaths can cause?

A

Infections

Damage to skin on penis

43
Q

What is a catheter?

A

A tube inserted into the bladder that drains urine out of the bladder

44
Q

What are the two main types of catheter?

A

Intermittent self catheterisation: inserted only to empty the bladder then they are taken out

Indwelling: remain in the bladder continuously

45
Q

What type of patients are best suited to intermittent self catheterisation (ISC)?

A

People with overflow incontinence who need to empty their bladders to prevent overfilling

People with good mental ability and dexterity

Not good for patients with stress or urge incontinence because the catheter is most often not in, so intermittent leaking won’t be prevented

Good as it means patients don’t have to carry a bag on them, they are just the same as normal except when they go to the toilet

46
Q

What types of indwelling catheters are there?

A

Urethral: go into the bladder via the urethra

Supra-pubic: go into the bladder via an incision in the abdominal wall

47
Q

What type of patients are best suited to indwelling urethral catheters?

A

People will areflexic bladders which continually leak

People with urinary retention

People who are not capable of ISC due to mental or physical impairment

48
Q

What type of patients are best suited to indwelling suprapubic catheterisation?

A

People who are likely to need a catheter for a long time or for life

People with damaged urethra

People who are at high risk of UTI

Genitourinary (13 decks)

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