INCONTINENCE AND URINARY RETENTION

Question 1

what’s the function of the bladder?

Answer 1

collection and low-pressure storage of urine

expulsion of urine at appropriate time and place

Question 2

outline the histology of the urinary bladder?

Answer 2

outer adventitial connective tissue layer, middle smooth muscle layer - detrusor muscle, innermost transitional cell epithelium

Question 3

outline the involuntary stage of micturition reflex? (common in infants and young children)

Answer 3

when the bladder is full, stretch receptors in the wall of the bladder send nerve impulses to sacral region of spinal cord. by way of a parasympathetic response, signals return to the bladder and signal contraction of detrusor muscle and relaxation of internal urethral sphincter

Question 4

outline the voluntary micturition reflex?

Answer 4

when bladder is full, stretch receptors initiate signal to the pontine micturition centre. at times when its not convenient to urinate, centre sends inhibitory sphincter to keep external urethral sphincter closed. when you wish to urinate, this inhibition is removed and the spinal cord controls the detrusor muscle of the bladder to contract and urethral spinchters to relax to let the urine out

Question 5

what is a parasympathetic nerve in the micturition reflex?

Answer 5

the pelvic nerve - it releases ACH which binds to M3 on detrusor muscle causing contraction

Question 6

what is the somatic nerve in the micturition reflex?

Answer 6

pudendal nerve - releases ACH which acts on nicotinic receptors causing contraction of external urethral sphincter

Question 7

outline how we get relaxation of the detrusor muscle?

Answer 7

pre-sympathetic nerve fibres synapse at a ganglion and pass info to hypogastric nerve which releases NA at the beta 3 receptor causing relaxation of detrusor muscle = allows bladder to fill

Question 8

what is the capacity of the bladder?

Answer 8

400-600ml

Question 9

how do the male and female urethras differ?

Answer 9

males have a much longer urethra which is divided into 3 segments.
the urethra in men is also the common duct for urinary and reproductive system whilst females have 2 separate systems

Question 10

what is cystometry?

Answer 10

a test used to look for problems with the filling and emptying of the bladder.

Question 11

how does cystometry work?

Answer 11

it measures detrusor pressure during controlled bladder filling and voiding

Question 12

where do we have catheters during cystometry and why?

Answer 12

in the bladder to find total bladder pressure and in the rectum to measure intra-abdominal pressure. total bladder pressure- intra abdominal pressure = intrinsic pressure of bladder

Question 13

what are LUTS?

Answer 13

lower urinary tract symptoms (bladder, prostate and urethra)
e.g. hesitancy, poor/intermittent stream, straining, prolonged micturition, dribbling, incomplete emptying, urgency to go

Question 14

why is LUTS more common in men?

Answer 14

because benign prostate enlargements is a very common cause

Question 15

what can cause voiding difficulties?

Answer 15

nerve disease, spinal cord injury, prostate enlargement, infection, surgery, medication, bladder stone, constipation, cystocele, rectocele, or urethral stricture.

Question 16

what is rectocele?

Answer 16

wall of tissue between a woman’s rectum and vaginal wall weakens.

Question 17

what is cystocele?

Answer 17

when the wall between the bladder and the vagina weakens

Question 18

what is prostatic obstruction?

Answer 18

obstruction of urine flow through the prostate due to pressure from the prostate against the urethra

Question 19

what is acute urinary retention

Answer 19

the abrupt development of the inability to pass urine -over a period of hours.

Question 20

what are common causes of acute urinary retention?

Answer 20

enlarged prostate, bladder outlet obstruction, pelvic organ prolapse, urinary tract stone, constipation

Question 21

what is urinary incontience?

Answer 21

when urine leaks as you feel a sudden, intense urge to pee, or soon afterwards

Question 22

what are the 4 types of urinary incontinence

Answer 22

stress, urge, overflow, and functional

Question 23

what is stress incontinence?

Answer 23

physical movement or activity e.g. coughing puts pressure on your bladder, causing you to leak urine.

Question 24

what is urge incontinence?

Answer 24

when you have a strong, sudden need to urinate that is difficult to delay

Question 25

what is overflow incontinence?

Answer 25

the involuntary release of urine when the bladder becomes overly full, even though the person feels no urge to urinate

Question 26

what is functional incontinence?

Answer 26

It occurs when the person’s bladder and/or bowel is working normally but they are unable to access the toilet. This may be due to a physical or a cognitive condition.

Question 27

what is mixed incontinence?

Answer 27

a combination of stress and urge incontinence

Question 28

what are some causes of urinary incontinence?

Answer 28

weak bladder muscles, overactive bladder muscles, weak pelvic floor muscles, damage to nerves controlling bladder muscles, blockage causing abnormal communications in the urinary tract

Question 29

what are some risk factors for urinary incontinence?

Answer 29

pregnancy, age, menopause, obesity, constipation, pelvic organ prolapse, chronic cough, smoking, excessive weight lifting, high impact aerobics

Question 30

what’s the impact of urinary incontinence?

Answer 30

worrying about activities causing stress e.g. coughing
worrying about incontinence worsening as they get older
worried about smelling of urine
being embarassed
worried about sexual intercourse, limited choice in clothing

Question 31

what lifestyle changes can you make to manage incontinence?

Answer 31

decrease caffeine, alter how much fluid you drink a day, losing weight

Question 32

what is behavioural therapy for incontinence?

Answer 32

pelvic floor exercises, vaginal weights, electrical stimulation

Question 33

what are some pharmacological agents for managing incontinence?

Answer 33

alpha-adrenergic agonists, antimuscarinics, Mirabegron, oestrogen, tricyclic antidepressants

Question 34

what are some surgical treatment options for incontinence?

Answer 34

urethral and bladder neck stabilising procedures, arterifical urinary sphincters

Question 35

what are urethral bulking injections?

Answer 35

when bulking agents are injected into the walls of the urethra to help close the sphincter. The goal of a urethral bulking injection is to help patients gain control over their urine flow.