L8: incontinence and urinary renention Flashcards
2 functions of the urinary bladder
collection and low pressure storage of urine
expulsion of urine
3 histological layers of the bladder
outer adventitial connective tissue layer
middle smooth muscle coat (detrusor)
innermost transitional cell epithelial
parasympathetic nerve roots for micturition are at?
S2-S4
3 nerves to the bladder
pelvic
pudendal
hypogastric
which nerve to the bladder is parasympathetic
pelvic nerve
what does the pelvic nerve control
contractions of the bladder (M3 receptors)
which nerve to the bladder is sympathetic
hypogastric
what does the hypogastric nerve control
internal sphincter
what does the pudendal nerve control
external sphincter
what brain centre controls voiding
pontine micturition centre in the brain
what needs to be coordinated in voiding
detrusor contraction and urethral relaxation
is any residual urine in bladder
NO
in cytometry to measure bladder pressure where do the catheters need to go
one in bladder
one in rectum
cytometry equation to work out bladder pressure
bladder pressure - abdominal pressure
LUTS=
lower urinary tract symptoms
BPH=
benign prostatic hyperplasia
BPE=
benign prostatic enlargement
BOO=
bladder outflow obstruction
name 5 symptoms of voiding issues
weak or intermittent stream straining hesitancy terminal dribbling incomplete emptying
what did voiding issues used to be called
obstructive
what did storage issues used to be called
irritative
name 5 symptoms of storage issues
urgency
frequency
incontinence
nocturia
post micturition symptom=
terminal dribbling
3 causes of voiding difficulty
- increased outflow resistance
- detrusor muscle failure
- BPH
where can the obstruction be to cause increased outflow resistance (3)
bladder neck
prostate
urethral stricture
what can cause detrusor muscle failure
Bladder outflow obstruction (BOO)
what is acute urinary retention
painful inability to void which is relieved by drainage
volume to classify as urinary retention
500-800cc
if more than 800cc urine retained=
acute on chronic retention
who is BOO and retention uncommon in
women
causes of retention in women
urethral obstruction
neurological (spinal injury)
2 drug therapies for BOO
alpha blockers
5-alpha reductase inhibitors
how can detrusor failure present
in voiding difficulties
if the bladder is palpable above the pubic synthesis how much urine is retained
> 500ml
what does dribble indicate about the bladder in detrusor failure
that function is not completely lost
urinary incontinence=
involuntary loss of urine
4 types of urine incontinence
stress
urge
mixed
overflow
what is stress incontinence
weakness of the urinary outlet
urge incontinence=
failure of bladder to store urine due to high bladder pressure
mixed incontinence=
weakness of urinary outlet and bladder storage
overflow incontinence=
an overfull bladder that overflows
when would stress incontinence happen
by increasing abdominal pressure (cough0
name 5 risk factors for incontinence
- pregnancy/childbirth
- age/menopause
- obesity
- constipation
- chronic cough
4 treatments for female urinary incontinence
-lifestyle changes
-behaviour therapy
-Drugs
surgical options
drugs for urinary incontinence
alpha- adrenergic agonists
Tricyclic antidepressants
2 surgical options for incontinence
- elevation or support of the bladder neck
- enhance urethral resistance
3 treatments for an overactive bladder
treat underlying cause
behavioural therapy
anticholinergics
