L6 Urinary incontinence and urinary retention 2025 Flashcards
action of muscles during urination
detrusor muscle contracts and pelvic floor relaxes
pelvic floor muscles can control the release of
urine, faeces and flatus
micturition center in the pons stimulate parasympathetic neurons, which leads to
contracion of detrusor muscle
micturition center in the Pons ibhibits sympathetic neurons, which causes
internal urethral sphincter to relax
what is the action of external urethral sphincter and pelvic floor muscles during urination
relax
injury to which part of spinal cord causes urinary incontinence
S2 to S4
what injuries/ disorders/ issues will cause urinary incontinence (3)
- brian or CND disorders
- constipation
- bladder irritation
what procedures will cause urinary incontinence (2)
- urologic, prostatic and gynecologic procedure
- chemotherapy and radiation therapy
what drug-drug interaction from polypharmacy will cause urinary incontinence (4)
- anticholinergic
- calcium channel blockers
- diuretics
- sedative
increase in what pressures leads to stress incontinence (2)
abdominal and detrusor
can urethra tighten sufficiently to overcome the increased detrusor pressure in stress incontinence
no
how labour causes stress incontinence (2)
- weakening of bladder neck supports associated with childbirth
- vaginal prolapse from vaginal birth or aging
deficiency of what muscle leads to stress incontinence and why it happens
internal sphincter (eg congenital conditions)
what causes acquired anatomic damage to the urethral sphincter (3)
- radiation therapy
- trauma
- prostatectomy
what actions cause urine loss in stress incontinence (4)
- physical exertion
- cough
- sneeze
- exercise
large or small volume of urine lost per exertion in stress incontinence
small
volume of post-void residual urine in bladder in stress incontinence
not more than 50ml
is the voiding habits of stress incontinence normal or not
normal
what exercises can improve stress incontinence
pelvic floor muscle exercises
suggest one life modifications to improve stress inconvinence
weight loss
name two external devices to improve stress incontinence of male
- external condom catheter
- penile clamp
does patients with urge incontinence have a strong desire to urinate
yes
can the signal from the bladder to the brain for urination reminder be suppressed in urge incontinence
no
what diseases/ disorders can cause urge incontinence
- idiopathic
- brain and nerve disorders
- bladder inflammation and infection
- bladder cancer
- overactive bladder
what causes overactive bladder
over activity of the detrusor muscle
symptoms of urge incontinence
- abrupt and strong urge to void
- may have loss of large amounts of urine with each occurence
treatment of urge incontinence (6)
● Treat underlying causes
● Pelvic floor muscle exercise
● Bladder training/ Time voiding
● Lifestyle modifications,
e.g., prevent constipation
● Anticholinergic drugs,
e.g.: Oxybutynin
● Containment devices,
e.g ., external condom catheters
and absorbent products
what is mixed incontinence
- combination of stress and urge incontinence
- leakage of urine associated by urgency and exertion, effort, sneezing or coughing
which groups of people have higher risk of mixed incontinence (3)
- old age
- men with post-prostatectomy incontinence, up to 50% have bladder dysfunction (poor compliance or instability)
- women with stress incontinence, up to 60% have symptoms or urgency and urge incontinence
what is overflow incontinence (3)
● Involuntary loss of urine associated with over distention of the bladder
● Obstruction of urethra (fail to relax sufficiently to allow urine to flow flow)
● Frequent with small volume urine loss
cause of overflow incontinence (3)
● Anatomic obstruction by enlarged prostate , large cystocele, faecal impaction
● Detrusor underactivity
● Detrusor areflexia (detrusor muscle cannot contract) associated with diabetes neuropathy or low spinal cord injury
symptoms of overflow incontinence (3)
● Bladder distention (up to the level of the umbilicus)
● Constant dribbling of urine
● Frequent with small volume urine loss
treatment of overflow incontinence (4)
● Urinary catheterization/ intermittent catheterization to decompress bladder
● α-adrenergic antagonists/ blockers
● Surgery to correct underlying problems
● Intravaginal device, such as pessary to support prolapse
what is functional incontinence
Leakage of urine caused by factors other than disease of lower urinary tract
causes of functional incontinence
● Decreased cognition, e.g. dementia , CNS disorders; inability to walk to the toilet
● Immobility
● Physical restraints
● Unavailability of regular toileting assistance
● Depression
symptoms of functional incontinence (2)
- quantity and timing of urine leakage vary
- patterns of urination are difficult to discern
treatment of functional incontinence (5)
● Environment or care plan modification
● Facilitate regular, easy access to toilet and promote patient safety
● Better lighting, ambulatory assistance equipment, clothing alterations
● Timed voiding and have a scheduled time to urinate
● Different toileting equipment
what drugs will be used in drug therapy of urinary incontinence
- alpha adrenergic blocker
- anticholinergic drugs (muscarinic receptor blockers)
- Botox
how can alpha adrenergic blocker relieve urinary incontinence
Relax the smooth muscle of the bladder neck and prostatic urethra
what type of urinary incontinence can we use anticholinergic drugs
urge UI
how does anticholinergic drugs help relieve urge UI
- Block the action of acetylcholine at muscarinic receptors
- Relax bladder muscle and inhibit overactive detrusor contractors
adverse effect of anticholinergic drugs (4)
- dry mouth and eyes
- constipation
- blurred vision
- sleepiness
what situation does Botox target for
detrusor over activity
how to use Botox
inject into the bladder
actions of Botox (2)
- relax the bladder and increase in storage capacity
- block release of acetylcholine
what lifestyle modifications can we do to reduce/ eliminate risk factors of urinary incontinence
● Adequate fluid intake
● Smoking cessation
● Weight reduction
● Good bowel regimen
● Reduction of bladder irritant, e.g., caffeine,
alcohol, artificial sweetener, citrus juices
bladder retaining and urge-suppression strategies (5)
● Scheduled toileting with progressive voiding intervals
● Teaching of urge urge-control using relaxation and distraction techniques
● Self -monitoring
● Reinforcement techniques
● Conscious contraction of pelvic floor muscles
Habit retraining
Scheduled toileting with adjustment of voiding intervals (longer or shorter) based on the person’s voiding pattern
Timed voiding
Toileting on a fixed schedule (typically every 2-3 hrs during waking hours)
Prompted voiding
- Scheduled toileting that requires prompts to void from a caregiver (typically every 3 hrs)
- Usted in conjunction with operant conditioning continence and appropriate toileting with progressive voiding intervals
What muscles do pelvic floor muscle exercises involve
- Involves voluntary contraction and relaxation of the levator ani muscle
Functions of pelvic floor muscle exercises
- Increase muscle volume
- Increase the strength and endurance of muscles
- Prevent downward rotation of the urethra and involuntary loss of urine
- Increase urethral closure pressure
- Allow stronger reflex contractions following a quick rise in intra-abdominal pressure
- Increase support to the urethral sphincter and detrusor muscle
Which types of urine leakage can pelvic floor muscle exercises prevent?
- Stress
- Urge
- Mixed
How to perform slow twitch exercise
- Sustain contraction for up to 5-10 seconds with equal periods of rest between contractions
- Repeat 10 times for one cycle
- 5-6 cycles per day at the beginning
- then 3 cycles/ day for maintenance
How to perform twitch exercise
- Contract 1 sec. rest 1 sec, repeat 10 times for one cycle
- perform after the slow twitch exercise
What is incontinence clamps (penile compression devices)?
- Applied to the penis
- Prevent any flow or leakage via the urethra
- Must be released to void
What is intraurethral occulsive device (urethral plug)
- Worn in the urethra
- Mechanical obstruction to prevent urine leakage
- Removed for voiding
What are the functions of intravaginal support devices (pessaries and bladder beck support prostheses)
- Support bladder neck
- Relieve minor pelvic organ prolapse
What is absorbent products
