Incontinence Flashcards
What is urinary incontinence/
Uncontrolled leakage of urine
Why is urinary incontinence important?
It is a common and distressing problem, with large impact on QoL
What is faecal incontinence?
Inability to control the passage of gas or stools through the anus.
What is nocturia?
Need to wake during the night to pass urine >2 times
What is nocturnal enuresis?
Urinary incontinence whilst sleeping
What is hesitancy?
Difficulty starting or maintaining flow of urine
What is urgency?
Sensation of imminently needing to pass urine
What is frequency?
Need to pass urine more often than normal
What is functional incontinence?
the patient is unable to reach the toilet in time
Give 2 causes of functional incontinence?
- Poor mobility
- Unfamiliar surroundings
What is stress incontinence?
Involuntary leakage of urine on effort or exertion, or sneezing or coughing
What is urge incontinence?
Involuntary leakage accompanied by, or immediately preceded by, urgency of micturition – there is a sudden and compelling desire to urinate that cannot be deferred
What is mixed incontinence?
Involuntary leakage associated with urgency and stress
What is overflow incontinence?
When bladder becomes dilated or flaccid, with minimal or no tone/function
What is true incontinence?
Continuous leakage of urine
How is continence maintained?
By the co-ordinated interaction of the bladder, urethra, pelvic floor muscles, and the nervous system
What happens to the pressure in the bladder as it fills?
Increases slowly
What rate does the bladder fill?
Usually 0.5-5ml per hour
What is the capacity of the bladder?
500ml
At what level of bladder fullness will the desire to void be felt?
About 250ml
When is continence maintained, with regard to pressure?
When pressure in the urethra exceeds bladder pressure
What does the process of micturition involve?
The voluntary relaxation of striated muscle around urethra, reducing urethral pressure, and a corresponding increase in bladder pressure as a consequence of detrusor contraction
What kind of nervous control is passing of urine under?
Parasympathetic
Where do bladder afferent signals travel?
From the bladder, ascend through the spinal cord and then project to pontine micturition centre and cerebrum
What nervous signals are sent from the pontine micturition centre upon the voluntary decision to urinate?
Neurones of the pontine micturition centre fire to excite the sacral preganglionic neurones
What is the result of the excitation of the sacral preganglionic neurones on the conscious decision to urinate?
There is parasympathetic stimulation to the pelvic nerve (S2-4) causing a release of ACh
What does the ACh released by the pelvic nerve cause?
Works on M3 muscarinic ACh receptors on the detrusor muscle, causing it to contract and increase intra-vesicular pressure
Other than sending nervous signals to the sacral preganglionic neurones, what is the role of the pontine micturition centre?
Inhibits Onuf’s nucleus
What is the result of the inhibition of Onuf’s nucleus?
Reduction in sympathetic stimulation to the internal urethral sphincter causing relaxation
What happens to the external urethral sphincter during micturition?
There is a conscious reduction in voluntary contraction of the external urethral sphincter, allowing for the distention of the urethra and passing or urine
What assists urination in the female?
Gravity
What assists urination in the male?
Bulbospongiosus contractions and squeezing along the length of the penis
What can cause stress UI?
- Urethral hypermobility
- Sphincter deficiency
What structures can be involved in urethral hyper mobility?
- Pelvic floor muscle
- Urethral support
What structures can be involved in sphincter deficiency?
- Pudendal innervation
- Urethral striated muscle
- Smooth muscle function
When is stress UI most commonly seem?
After childbirth