Incontinence Flashcards
What part of the autonomic nervous system causes contraction of the neck of the bladder and the internal urethral sphincter?
Sympathetic Nervous System - a-adrenoreceptor
What part of the autonomic nervous system causes contraction of the bladder?
Parasympathetic Nervous System
What part of the autonomic nervous system controls relaxation of the bladder?
Sympathetic - ß - adrenoreceptor
What are irreversible (but treatable) causes of urinary incontinence?
- Prostatic hypertrophy - overflow incontinence
- Overactive bladder syndrome/detrusor overactivity
- Stress incontinence - pelvic muscle weakness
- Fistula - bladder to vagina
What part of the nervous system controls the external urethral sphincter?
Somatic nervous system
What is the approximate volume at which the sensation of needing to void becomes apparent?
Approximately 200 mls
What are reversible causes of urinary incontinence?
- UTI
- Delerium
- Medications - diuretics, anticholinergics
- Constipation - leading to faecal impaction
- Polyuria
- Urethral irritability - vaginal atrophy
- Prolapse
- Bladder stones and tumours
What environmental factors can increase the risk of incontinence?
- Bed bound
- Reduced mobility
- Where the toilet is/ease of access
What would you ask about when assessing urinary incontinence?
- Urgency symptoms - time between needing to go and voiding, know when they need to pass urine
- Stress symptoms -laughing, weight lifting
- Obstructive symptoms - force, hesitancy, dribbling
- Polyuria
- Dysuria
What is stress incontinence?
Involuntary leakage on effort or exertion, on sneezing or coughing. Most commonly due to a weak bladder outlet
What are the symptoms of stress incontinence?
Urine leak on movement, coughing, laughing, squatting, etc.
How would you evaluate someone with stress incotinence?
- Examination
- Dipstick
- General bloods
What medical treatment would you use to treat stress incontinence?
- Physio - pelvic floor exercises
- Oestrogen cream
- Duloxetine - SSRI
What is urge incontinence?
Involuntary leakage accompanied by or immediately preceded by urgency (immediate need)
A symptom complex usually, but not always, related to urodynamically demonstrable detrusor overactivity (DO)
What is urinary retention with overflow incontinence?
This is where the outlet of the bladder does not relax properly, or the detrusor muscle is too weak. Over time, urine builds up within the bladder and causes incontinence due to overflow
What surgery can be used to correct stress incontinence if no other treatment has worked?
TVT/colposuspension - 90% cure at 10 years
What are the features of urge incotinence?
- Urgency - may have incontinence
- Frequency
- Nocturia
What can cause urge incontinence?
- Bladder Stones
- Stroke/Parkinsons
- UTI
- Diabetes
- Atrophic vaginitis
- Urethritis
How would you treat urge incontinence?
-
Anti-cholinergics - relax detrusor by suppressing parasympathetic innervation of the bladder
- Oxybutinin, tolterodine, solifenacin
- Botulinum toxin A - relaxes detrusor
What are characteristics of urinary retention with overflow incontinence?
- Poor urine flow
- Double voiding
- Hesitancy
- Post micturition dribbling
How would you treat urinary retention with overflow incontinence?
-
Alpha-blockers - act on the internal urethral sphincter
- Tamsulosin
- Anti-androgen - shrinks prostate
- Catheter insertion
- Surgery - TURP
What can cause raised residual bladder volume in an elderly patient?
- Prostatic hypertrophy
- Urethral stricture
- Bladder diverticulum
- Pelvic organ prolapse - female only
- Hypocontractile detrusor
- Bladder tumour
- Drugs