Lecture 7.2: Urinary Incontinence

Question 1

What are some reasons for Urinary Incontinence?

Answer 1

• Urinary Tract Infections
• Pelvic floor injury secondary to
  childbirth (women)
• Generic loss of Muscle Tone (ageing)
• Detrusor Overactivity
• Damage to the CNS
• Damage to Pelvic Nerves

Question 2

What are some reasons for Urinary Retention?

Answer 2

• May develop secondary to
  enlargement of the prostate gland
• Kidney Stones

Question 3

What are Rugae?

Answer 3

• A series of ridges produced by folding
  of the wall of an organ
• Invaginations that disappear when the
  bladder is filled

Question 4

What is the Trigone in the Bladder?

Answer 4

It is the area between the ureteral openings and the urethra. It funnels the urine into the urethra and forms a “fixed base” for the bladder

Question 5

Lower Urinary Tract Symptoms (LUTS): Storage

Answer 5

• Frequency
• Urgency
• Nocturia
• Incontinence

Question 6

Lower Urinary Tract Symptoms (LUTS): Voiding

Answer 6

• Slow stream
• Splitting or spraying
• Intermittency
• Hesitancy
• Straining
• Terminal dribble

Question 7

Lower Urinary Tract Symptoms (LUTS): Post-Micturition

Answer 7

• Post-micturition dribble
• Feeling of incomplete emptying

Question 8

Stress Urinary Incontinence (SUI)

Answer 8

The complaint of involuntary leakage on effort or exertion, or on sneezing or coughing

Question 9

Urge Urinary incontinence (UUI)

Answer 9

The complaint of involuntary leakage (of urine) accompanied by or immediately proceeded by urgency

Question 10

Mixed Urinary Incontinence (MUI)

Answer 10

The complaint of involuntary leakage (of urine) associated with urgency and also with exertion, effort, sneezing or coughing

Question 11

Overflow Incontinence

Answer 11

Involuntary release of urine due to a weak bladder muscle or to blockage—when the bladder becomes overly full, even though the person feels no urge to urinate.

Question 12

Lower Motor Neuron Lesion (S2, 3, 4)

Answer 12

• Low detrusor pressure
• Large residual urine+/- Overflow
  incontinence
• Reduced perianal sensation

Question 13

Upper Motor Neurone Lesion

Answer 13

• Detrusor sphincter dyssynergia
• Dilated ureters
• Thickened detrusor
• High pressure detrusor contractions
• Poor coordination with sphincters

Question 14

Drugs used to Treat Incontinence

Answer 14

• Antimuscarinic drugs (e.g. axybutynin):
  useful but present side effects such as
  dry mouth and constipation (because
  M3 receptors are present in salivary
  glands and gut)
• Botulinum toxin: very effective but
  administration is difficult
• Resiniferatoxin and capsaicin (target
  sensory nerves)