Incontinence Flashcards
What are the extrinsic factors causing incontinence?
Physical state and co-morbidities Reduced mobility Confusion Drinking too much or at wrong time Medications Constipation Home or social circumstances
What maintains continence?
Bladder and urethra
Local innervation
CNS connection
What is the function of the bladder?
Urine storage and voluntary voiding
What muscles maintain continence?
Detrusor (smooth)
Internal Urethral Sphincter (Smooth)
External urethral sphincter (striated)
Describe the parasympathetic innervation of the bladder?
s2-s4
Increases strength and frequency of contractions
Descrive the sympathetic innervation of the bladder?
T10-L2
Causes detrusor to relax
T10-S2
Causes contraction of neck of bladder, and internal urethral sphincter
Describe somatic innervation of the bladder?
S2-S4
Contraction of pelvic floor muscle and external urethral sphincter
What are the intrinsic factors causing incontinence?
Bladder
Outlet
Either too weak or too strong
What is stress incontinence?
Bladder outlet too weak
- urine leak on movement, coughing, laughing and squatting
- weak pelvic floor muscles
- Common in women with children
What are the treatments for stress incontinence?
Physiotherapy, oestrogen cream and duloxetine
TVT/Colposuspension
What causes urinary retention with overflow incontinence?
Bladder outlet too strong
What are characteristics of overflow incontinence?
Poor urine flow, double voiding, hesitancy, post micturition dribbling
How is overflow incontinence treated?
Catheterisation, often suprapubic
What is urge incontinence?
Bladder muscle too strong where detrusor contracts at low volumes
What are the characteristics of urge incontinence?
Sudden urge to pass urine immediately
