Incontinence Urinary Flashcards
Urine filters from the kidneys down to the bladder through the ureters and then is removed from the bladder via the urethra. What is the name of the special type of muscle that the bladder is composed of?
1 - psoas muscle
2 - detrusor muscle
3 - inguinal muscle
4 - pelvic muscle
2 - detrusor muscle
- this is able to stretch as the bladder fills
What type of cells are contained within the bladder that allows the bladder to stretch?
1 - stratified transitional epithelial cells
2 - stratified columnar cells
3 - pseudostratified squamous epithelial cells
4 - squamous epithelial cells
1 - stratified transitional epithelial cells
Roughly how much urine can the bladder store?
1 - 100-200ml
2 - 200-300ml
3 - 500-750ml
4 - 1000-2000ml
3 - 500-750ml
- slightly less in women as the uterus takes up space
The bladder contains an internal and external sphincter. Which one is autonomous and not under our control?
- internal sphincter
- composed of smooth muscle and opens when the bladder is half full
The bladder contains an internal and external sphincter. Is the external sphincter composed of smooth or skeletal muscle?
- skeletal muscle
- under voluntary control and allows us to stop urine flow by contracting called Kegel exercises
When the bladder begins to fill, stretch receptors sends a signal to the spinal cord, called the micturition centre. What level is this at in the spinal cord?
1 - L4-L5
2 - L5-S2
3 - S1-S2
4 - S2-S4
4 - S2-S4
When the bladder begins to fill, stretch receptors sends a signal to the spinal cord, called the micturition centre in the sacrum at S2-S4. These is also a signal sent to the brain, specifically which part of the brain?
1 - hippocampus
2 - pons
3 - midbrain
4 - medulla
2 - pons
- pontine micturition centre
- pontine storage centre
When the micturition centre in the spinal cord is stimulated at S2-S4 by stretch receptors in the bladder, does this affect the sympathetic or parasympathetic system?
- both
- part of micturition reflex
- decreases sympathetic and increased parasympathetic
When the micturition centre in the spinal cord is stimulated at S2-S4 by stretch receptors in the bladder this reduces the sympathetic and increases the parasympathetic activity, all part of the micturition reflex. Does this cause the detrusor muscle to contract or relax?
- contract as in rest and digest = parasympathetic
When the micturition centre in the spinal cord is stimulated at S2-S4 by stretch receptors in the bladder this reduces the sympathetic and increases the parasympathetic activity, all part of the micturition reflex. Does this cause the internal sphincter to contract or relax?
- relax and allow urine to leave the bladder
- as in rest and digest = parasympathetic
- has a moderate effect on relaxing the external sphincter as well
If we want to urinate does the pontine micturition centre or pontine storage centre override the micturition reflex and stop us from urinating?
- pontine storage centre
- as in it stores the urine
- if we want to urinate the pontine micturition centre allows for the micturition reflex to occur
Which nerve is important for being able to contract the external sphincter and thus control when to urinate?
1 - hypogastric nerve
2 - sciatic nerve
3 - pudendal nerve
4 - superior gluteal nerve
3 - pudendal nerve
There are lots of different types of incontenance. What is urge incontenance?
1 - small leakage of urine occurs on physical exertion due to stress on bladder
2 - unable to control urination due to involuntary bladder contractions and then urination
3 - urethra and flow of urine is blocked
4 - both urge and stress incontenance
5 - bladder fills but does not empty properly causing continuous dribbling
2 - unable to control urination due to involuntary bladder contractions and then urination
- Idiopathic (most common)
- Neurogenic
- Infective
- Bladder outlet obstruction
Urge incontenance is the inability to control urination due to involuntary bladder contractions and then urination, with idiopathic being the most common cause. Conservative management includes reducing fluids and avoiding irritants (caffeine, alcohol), but which 2 of the following are key medications that can be used to treat urge incontenance?
1 - botulinum
2 - memantine
3 - solifenacin
4 - duloxetine
1 - botulinum
- inhibits release of ACh, inducing paralysis and relaxed bladder
3 - solifenacin
- anti-cholinergic so inhibits ACh binding and reduce detrusor muscle contraction
There are lots of different types of incontenance. What is stress incontenance?
1 - small leakage of urine occurs on physical exertion due to stress on bladder
2 - unable to control urination due to involuntary bladder contractions and then urination
3 - urethra and flow of urine is blocked
4 - both urge and stress incontenance
5 - bladder fills but does not empty properly causing continuous dribbling
1 - small leakage of urine occurs on physical exertion due to stress on bladder
- this is essentially due to weakness of sphincters
Risk factors:
- female gender
- age
- previous pelvic surgery
- neurological disease
- UTI
- post-menopausal
- post-hysterectomy
- bladder outlet obstruction
Stress incontenance is when there are small leakages of urine during physical exertion and stress being placed on the bladder. This is typically due to weakness of sphincters. There are lots of conservative approaches including weight loss, pelvic floor exercises and physiotherapy, but which of the following medications is often prescribed to treat this?
1 - botulinum
2 - memantine
3 - solifenacin
4 - duloxetine
4 - duloxetine
- serotonin and norepinephrine (NE) reuptake inhibitors
- improves function of pudendal nerve, thus improving control of the external sphincter
Stress incontenance is when there are small leakages of urine during physical exertion and stress being placed on the bladder. This is typically due to weakness of sphincters. All of the following are surgical procedures for this, but which is the most common?
1 - colposuspension
2 - transobturator taping
3 - transvaginal tape or sling
4 - urethral bulking agent injection
3 - transvaginal tape or sling
- but colposuspension has the best long term success
There are lots of different types of incontenance. What is mixed incontenance?
1 - small leakage of urine occurs on physical exertion due to stress on bladder
2 - unable to control urination due to involuntary bladder contractions and then urination
3 - urethra and flow of urine is blocked
4 - both urge and stress incontenance
5 - bladder fills but does not empty properly causing continuous dribbling
4 - both urge and stress incontenance
There are lots of different types of incontenance. What is outflow incontenance?
1 - small leakage of urine occurs on physical exertion due to stress on bladder
2 - unable to control urination due to involuntary bladder contractions and then urination
3 - urethra and flow of urine is blocked
4 - both urge and stress incontenance
5 - bladder fills but does not empty properly causing continuous dribbling
3 - urethra and flow of urine is blocked
- almost always occurs in men
- phimosis
- benign prostate hyperplasia, stricture, trauma, blood clot, calculi, cancer of the bladder, prostate, cervix or colon, STIs (particularly in women)
There are lots of different types of incontenance. What is overflow incontenance?
1 - small leakage of urine occurs on physical exertion due to stress on bladder
2 - unable to control urination due to involuntary bladder contractions and then urination
3 - urethra and flow of urine is blocked
4 - both urge and stress incontenance
5 - bladder fills but does not empty properly causing continuous dribbling
5 - bladder fills but does not empty properly causing continuous dribbling
- continuous dribbling or symptoms of stress incontinence with large post-void residual volume
- can be caused by recurrent UTIs
- made worse by constipation or anticholinergics
- often occurs in men with prostatic obstruction
There are lots of different types of incontenance. What is functional incontenance?
1 - small leakage of urine occurs on physical exertion due to stress on bladder
2 - inability to reach and use the toilet
3 - urethra and flow of urine is blocked
4 - both urge and stress incontenance
5 - bladder fills but does not empty properly causing continuous dribbling
2 - inability to reach and use the toilet
- may be due to frailty or disability
All of the following are causes that can accentuate a patients incontenance, EXCEPT which one?
1 - bowel function (constipation)
2 - mobility/dexterity (unable to reach the toilet)
3 - medication
4 - nutrition
5 - medical conditions
6 - psychological conditions
4 - nutrition
- most of these causes can be treated if clinician is aware of them
When conducting a history with a patient, in reference to their urination habits, which of the following are RED flags to be aware of?
1 - Haematuria
2 - Persistent UTI
3 - Constitutional symptoms
4 - Poor renal function
5 - Abnormal neurology include saddle anaesthesia
6 - Recent back trauma or pelvic surgery
7 - all of the above
7 - all of the above
When managing a patient with urinary incontenance the treatment can be divided into 4 sections:
- Lifestyle advice/patient education
- MDT/non-pharmacological
- Medical management
- Surgical management
Which of the following is NOT a lifestyle intervention for incontenance?
1 - Smoking cessation
2 - Reduced fluid intake at specific times
3 - Weight reduction
4 - Managing constipation
5 - Reduce alcohol and caffeine intake
6 - Botulinum toxin
6 - Botulinum toxin
- limits detrusor muscle contractions
In some patients the use of anti-muscarinics can be used. These act by competitively binding against ACh, therefore reducing parasympathetic activity and detrusor muscle contraction. Which of the following is the core anti-muscarinic that we need to be aware of used to treat urinary incontenance?
1 - bisoprolol
2 - doxazosin
3 - digoxin
4 - solifenacin
4 - solifenacin
Solifenacin an anti-muscarinics that competitively binds against ACh, reducing parasympathetic activity and detrusor muscle contraction. However, it has a large adverse events profile, especially in the elderly. Which of the following are common?
1 - cognitive impairment, hallucinations
2 - blurred vision
3 - dry mouth
4 - tachycardia
5 - nausea, constipation
6 - urinary retention
7 - all of the above
7 - all of the above
- all are associated with the inhibiting the parasympathetic system
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