Incontinence Flashcards
somatic control of weeing
by pudendal nerve (S2-4) - ACh on a nicotinic receptor making your eus contract
parasympathetic control of weeing
pelvic nerve (S2-4) - ACh on a muscarinic receptor making you detrusor muscles contract
sympathetic control of weeing
hypogastric nerve (T10-L2) - NA on alpha receptor making your ius contract NA on beta receptor making you detrusor relax
ACh acts on which receptor types
nicotinic and muscarinic
NA/A act on which receptors types
alpha and beta
what type of incontinence results from a weak bladder outlet
stress incontinence
what type of incontinence is due to a weak pelvic floor and so is common in parous women
stress
treatment of stress incontinence
PFMT, oestrogen cream, duloxetine and surgery
how is duloxetine used to manage stress incontinence
used in moderate or severe incontinence as part of a strategy including PFMT
two types of surgery for stress incontinence
culposuspension and TVT (tension-free vaginal tape)
by what theory does culposuspension and TVT work in incontinence
hammock theory - by having the bladder lying low it may stimulate bladder neck receptors to prematurely micturate
what two types of incontinence is culposuspension and TVT used in
urge and stress
what is the problem in urge incontinence
bladder contracts too readily with a small volume and involuntarily
what proportion of women in nursing homes are incontinent
50%
investigations of incontinence
3 days urinary diary urine dipstick post voiding residual volume assessment urodynamics (uroflowmetry) cystometry
4 lifestyle changes to improve stress incontinence
stop smoking
lose weight
eat better to avoid constipation
stop drinking alcohol and caffeine
how does TVT work
bit of tape goes around the urethra and attaches to the front of the abdoominal wall
true/false TVT has higher operative and postoperative morbidity than colposuspension
false - less morbidity is associated
what is the 1st line surgical treatment
TVT
true/false - TVT can be curative
true - in 80% of cases
common complications of TVT
bladder perforation
vaginal and urethral erosions
what surgery option has a lower morbidity than TVT
TOT - has a comparable success rate too
what is overactive bladder syndrome
urge incontinence - urodynamically demonstrable detrusor overactivity
symptoms of overactive bladder syndrome
urgency +/- incontinence with frequency and nocturia
