Incontinence: Voiding Function Flashcards
lower urinary tract has two basic functions:
- storage of adequate volume of urine at low pressure; ensures contienence and protects kidneys
- voluntary and complete emptying
medications for SUI
innervation of the detrusor muscle
parasympathetic (motor efferent) innervation: Ach-receptors
the mucosa of the bladder sends ___ ___ to the SC and the brain
afferent sensation to the spinal cord and brain. allows us to detect stretch or pain
bladder outlet:
the internal __ muscle sphincter is innervated ___ via __- receptors.
the external __ muscle spincter is innervated __ via ___ receptors
the internal smooth muscle sphincter is innervated sympatehtically via ALPHA- receptors.
the external striated muscle spincter is innervated somatically via NIC receptors
what type of muscle is the pelvic floor composed of
striated muscle
the bladder and outlet has different innervation depending on the location. Outline this diagram in terms of which nerve and which transmitter is involved at each site.
Normal Voiding (micturition Cycle):
Bladder filling: the detrusor __, the urethra is _, and the pelvic floor is __.
First sensation to void: the detrusor is __, the urethra __ __, and the pelvic flood __.
the normal desire to void: the destrusor __, the urethra __, and the pelvic floor relaxes, allowing for __/urination.
Bladder filling: the detrusor relaxes, the urethra is contracted, and the pelvic floor is contracted.
First sensation to void: the detrusor is relaxed, the urethra contraction increases, and the pelvic flood contracts.
the normal desire to void: the destrusor contracts, the urethra relaxes, and the pelvic floor relaxes, allowing for micturition/urination.
the bladder then fills again.
Neurological steps of voiding:
- brain removes inhibition
- PMC (__ __ __) facilitates voiding:
- inhibits the sphincter/pelvic floor contraction via __ innervation
- removes inhibition to bladder muscle (__ innervation)
- stimulates contraction of bladder muscle via __ innervation - outlet __
- bladder __
- bladder empties
- outlet __
- bladder contraction ends
- inhibitory stimuli returns
- brain removes inhibition
- PMC PONTINE MUCTURITION CENTER facilitates voiding:
- inhibits the sphincter/pelvic fllor contraction via somatic innervation
- removes inhibition to bladder muscle (sympathetic innervation)
- stimulates contraction of bladder muscle via parasympathetic innervation - outlet relaxes
- bladder contracts
- bladder empties
- outlet contracts
- bladder contraction ends
- inhibitory stimuli returns
key symptoms of an overactive bladder (OAB)
frequecy, noctuia, urgency, +/- urge incontinence
2 forms of OAB and their causes
- sensory nervous bladder. due to increased firing from bladder or CNS is over-aware of bladder filling. these people usually sleep through the night
- motor nervous bladder. Day adn night-time frequency and urgency. May have urge incontinece
conservative management of overactive bladder
2 calasses of medications that can help with medical treatment of OAB. What is their MOA?
mainstay therapy are either antimuscarinics or beta 3 agonists
- they both work by inhibiting the detrusor overactivity and may block sensory signals
two first line antimuscarinics
side effects and contra-indications of antimuscarinics
side effects; dry mouth, dry eyes, constipation, confusion and drowsiness
contraindications; untreated narrow angle glaucoma, gastric retention (will make this worse), hypersensitivity
if a person with overactive bladder is refractory to conservative measures and to medications, which three surgical procedures may help things?
botox therapy
neuromodulation
bladder augmentation
T/F Dysfunctionally voiding involves the impaired relaxation of the sphincter in someone with a non=neurologically intact patient
false. the person IS neurologically intact. • Impaired relaxation of sphincter and/or
pelvic floor during voiding in neurologically intact patient
two key populations affected by dysfunctional voiding
- those who develop in childhood. happens during toilet training, with over-bearing parents, abuse. common cause of secondary reflux d/t high voiding pressures. at worst, can present with renal failure and bilateral hydronephropathy.
- devlops as an adult- following UTIs, surgery, abuse, high anxiety individials. commonly associated with pelvic pain, sensory urgency (OAB)
complications of pediatric dysfunctional voiding
renal failure and bilateral hydronephropathy.
treatment of dysfunctional voiding (DFV)
- proper diagnosis and education
- self cath program when necessary at least initially to avoid renal failure and bilateral hydronephropathy.
- pelvic floor rehab/
- neuromodulation
- renal monitoring when necessary
T/F; isolated nocturia is uaully a bladder issue involving irritation
false. not usually a bladder problem. usually its polyuria– caused by DI, DM, edema, sleep apnea.
6 broad types of incontinence
- stress
- urge
- mixed
- overflow
- total
- functional
should be able to differentiate by history
stress versus urge incontence region affected
stress– causes contraction or stimulation of the bladder muscles
urge; usually due to issues below the bladder- of the urethra or pelvic floor
3 main causes of total incontinence
- really really bad stress incontinence
- ectopic ureter
- fistula
most common cause of urinary incontinence
stress incontinence
MOA and causes of stress incontinence
develops due to relaxation of supportive structures under bladdder neck and urethra (pelvic floor), or impaired inward coaptation or urethra (AGE)
causes:
- childbirth
- hysterectomy and other surgery
- age and urogenital atrohpy, congenital weak tissues
- chronic pressure (cough, constipation)
evaluation of stress incontinence
conservatie management of stress incontinence
how does pelvic muscle training help with incontinence? what modalities are frequently used?
rationale: strengthens the pelvic musculature, improves voluntary activation and regain normal unconscious activation. imrpves sexual function
modalities: hegels, biofeedback, electrical stimulation, weighted cone devices.
medications for SUI
alpha agonists
estrogen
t/f for stress incontinence, the mainstay treatment is pelvic floor exercises
false. the mainstay of treatment is srurgery.
SLINGS ARE THE NEW GOLD STANDARD: either the tension free vaginal tape, or the transobturator tape.
Outline the gender differences in overactie bladder based on age.
in younger and middle age, women are often the ones to suffer more from overactive bladder. in the elderly, men more often have overactive bladder
