Lecture 6 Urinary incontinence Flashcards
The _ is also referred to as the “pelvic floor muscle”.
Pubococcygeal muscle.
Urge incontinence
- Involuntary urinary leakage due to the inability to hold urine long enough to reach a toilet after perceiving the urge to void.
- Results from detrusor instability or unstable bladder; the bladder muscles contract involuntarily during filling.
- Also known as overactive bladder.
Functional incontinence
- Urination due to the inability to reach an appropriate toileting facility.
- More likely to be an acute condition - barriers to the toilet, mobility limitations, restraints, etc.
Stress incontinence
- Leakage of urine as a result of an activity that increases abdominal pressure.
- Most common type of incontinence in younger women.
Mixed incontinence
The involuntary leakage of urine with both the sensation of urgency and activities such as coughing, sneezing, and exertion.
The detrusor motor area in the _ controls bladder function by directing micturition centers to initiate or to delay voiding depending on the social situation.
Cerebral cortex.
Pons micturition center
- Located in the brainstem - provides for automatic coordinated voiding (urethral sphincter opens before bladder contracts) in response to bladder filling.
- If the cerebral cortex (detrusor motor area) is damaged, voiding still occurs due to the action of the pons.
Sympathetic pathways and bladder function
- Tighten the bladder neck and relax the bladder muscle (detrusor).
- Contribute to urine storage and promote continence.
- Sympathomimetic agents such as pseudoephedrine, SNRIs, and anticholinergics cause urinary retention.
Parasympathetic pathways and bladder function
- Trigger release of neurotransmitters that cause the bladder to contract (acetylcholine).
- Even if all cortical and pontine control is lost, parasympathetic fibers in the sacral cord will still stimulate “reflex voiding.”
Anticholinergic drugs such as _ are commonly used to reduce urgency and frequency and promote continence.
Oxybutynin (Ditropan).
The _, located at the outlet of the urethra, provides for voluntary role of the urethral sphincter muscle.
Pudendal nerve. (Teaching Kegel exercises will be ineffective for patients with damage to this nerve.)
Nocturia
- Getting up at least 2 times during the night to urinate.
2. The consequence of normal age-related increases in urinary output at night.
Age-related changes affecting urinary function
- Increased production of urine at night.
- Reduced bladder capacity.
- Reduced strength of bladder contractions.
- Increased irritability of the detrusor muscle.
- Delayed recognition of bladder filling.
- Benign prostatic hyperplasia (BPH) in males; loss in estrogen in females.
- Effects of reduced mobility and multiple medications.
Symptoms of BPH include _
Hesitancy, poor urinary stream, prolonged urination time, incomplete emptying, and post-void dribbling.
Patients with tumors, kidney stones, or other potentially serious conditions should be _
Referred to the appropriate specialist for further evaluation.
_ and _ are associated with urge incontinence and mixed incontinence, but not with stress incontinence.
Urgency and frequency.
Overflow incontinence
- Inability to effectively empty the bladder.
- Often associated with BPH, medication side effects, and neuropathy.
- Most serious form of incontinence because the urine backs up in the ureters and into the kidneys.
- Symptoms: Urinary frequency, dribbling, leakage, and nocturia.
The type of incontinence that is characterized by urinary retention is _
Overflow incontinence.
A patient complaining of trouble initiating a urine stream and constantly dribbling is suffering from _
Overflow incontinence.
An elderly patient with dementia who forgets to go to the bathroom is probably suffering from _
Functional incontinence.
An elderly patient whose only bathroom is located on the second floor of their home is at risk for experiencing _
Functional incontinence.
A patient “losing urine” when bending over or getting up from a chair is experiencing _
Stress incontinence.
Mnemonic for assessment of urinary function
"DIAPPERS" (two Ps): D= Delirium I= Infection (or irritants) A= Atrophic vaginitis/urethritis P= Pharmaceuticals P= Psychological E= Excess urine production R= Restricted mobility S= Stool impaction
Alpha receptor antagonists are used for the treatment of _
BPH symptoms - promotes urethral relaxation and the resumption of a normal voiding pattern.
