Incontinence Flashcards
What major complication of incontinence are we so concerned about in the elderly?
FALLS
patients rushing to reach the toilet on time, and problematic if pt PU before reaching the toilet
how does prevalence of incontinence vary between men and women?
prevalence in men usually half that in women
examples of LUTS?
frequency
urgency
nocturia-need to pass urine during the night which wakens one from sleep and is an independent RF for falls
incontinence
define overactive bladder
syndrome including urinary urgency with or without urge incontinence, which is usually accompanied by frequency (voiding 8 or more times/24hr) and nocturia
can be associated with detrusor overactivity.
what is stress incontinence?
involuntary leakage of urine caused by failure for bladder outlet to remain closed during rises in intra-abdominal pressure
how is a diagnosis of detrusor overactivity confirmed?
requires urodynamic studies
what diagnosis does the following correspond to: spontaneous bladder contraction during filling as pt attempts to prevent micturition?
detrusor overactivity
what is nocturnal polyuria?
passing more than 1/3 of your urine volume during the night
can be identified by viewing frequency volume charts
types of urinary incontinence?
stress-result of weakness of the urinary outlet so fails to remain closed during rises in intra-abdo pressure e.g. coughing, laughing
urge-high bladder pressure causes bladder to fail in storing urine
overflow-bladder overfull due to bladder outlet obstruction e.g. BPH, so overflows
mixed-combination of stress and urge
functional-incontinence due to more general impairment e.g. cognitive-e.g. pt with dementia who has frontal cortex dysfunction so makes no attempt to move to the toilet before micturition, functional, affective, pt unable to get to the bathroom on time.
fistulae e.g. in crohns
what is necessary for the process of micturition?
there must be voluntary relaxation of the striated muscle around the urethra to reduce urethral pressure (pelvic floor muscles already not functioning adequately in stress incontinence) AND
corresponding increase in bladder pressure due to detrusor contraction-M3 muscarinic receptors stimulated by PNS
normal bladder capacity, and what volume causes a desire to void?
around 600ml
desire to void usually felt at around 250ml
primary muscle for inhibiting the release of urine?
internal urethral sphincter-smooth muscle, continuation of detrusor muscle, under autonomic (involuntary) control
how is detrusor contraction coordinated with urethral relaxation to allow micturition to take place?
by the pontine micturition centre in the midbrain
overview of how micturition is stimulated following bladder filling?
filling causes detrusor muscle of the bladder to stretch-increased signals sent to the sacral region, which then causes PNS stimulation of the detrusor via the pelvic nerves (S2-S4) to contract. stretching bladder also causes increased signals to be sent up to the brain, where the pontine micturition centre coordinates detrusor contraction with urethral relaxation-brain decreases APs in somatic motor neurones to the external urethral sphincter (pudendal nerve S2-S4).
if voiding not desired, inhibitor signals sent from the brain to the detrusor muscle (hypogastric nerve T10-L2 SNS).
most common cause of stress incontinence in men?
prostate damage, usually post-op following prostatectomy
structure most important for stopping stress incontinence in women?
peri-urethral striated muscle
useful questions for assessing urinary incontinence?
any problems with your bladder or bowels?
do you ever leak urine?
do you find it difficult to hold urine when you feel the urge to go?
do you have a problem with going to the toilet too often to pass urine during the day?
do you have to wake from sleep at night to pass urine?
storage symptoms?
frequency of micturition urgency of micturition continual urine loss nocturia urge incontinence stress incontinence
