mechanisms of incontinence

Question 1

what is incontinence

Answer 1

lack of voluntary control of excretory functions
can also occur alongside normal micturition

Question 2

list clinical syndromes involved with disorders of micturition

Answer 2

• inappropriate voiding
• inadequate voiding with an overflow of urine
• increased frequency
• reduced capacity
• incomplete voiding

Question 3

what is dysuria

Answer 3

difficult or painful passage of urine

Question 4

what is stranguria

Answer 4

straining or hesitancy associated with urination

Question 5

what is pollakuria

Answer 5

increased frequency of urination

Question 6

what is nocturia

Answer 6

urge to urinate overnight

Question 7

what is enuresis

Answer 7

unconscious leakage of urine during sleep

Question 8

how do you assess bladder size

Answer 8

ultrasound or plapation

Question 9

how do you assess urethral sphincter tone

Answer 9

• are they leaking urine
• squeeze, does urine come out and at what point

Question 10

how do you assess the integrity of the detrusor/micturition reflex

Answer 10

initiate urination by increasing pressure in the bladder

Question 11

a lower motor neuron bladder is

Answer 11

• due to sacral spinal segment damage or pelvic plexus damage
• absent voluntary micturition
• atonic bladder
• atonic urethral sphincters
• absent detrusor reflex
• concurrent reduced perineal reflex and anal tone
• flaccid and easily expressed

remember LMN disease = flaccid paralysis, hypo/areflexia and rapid muscle wastage

Question 12

and upper motor neurone injury bladder is:

Answer 12

• due to high spinal cord injury or brain dysfunction
• absent voluntary micturition
• increased urethral sphincter tone
• high volume urinary retention
• development or automatic bladder

remember UMN disease = spastic paralysis, hyper/normoreflexia and slow muscle wastage

Question 13

list disorders of the UT that are non neurological

Answer 13

• ectopic ureter
• acquired (neoplasia, calculi, trauma)
• functional outflow obstruction
• sphincter mechanism incompetence
• secondary detrusor muscle atony
• stretch injuries
• urge incontinence

Question 14

what is an ectopic ureter

Answer 14

• ureter inserts where its not supposed to (directly into the urethra
• congenital malformation, will see incontinence at young age, wont develop later in life
• urine dribbles out as fast as that kidney produces it
• if one ureter is attached normally you will see normal micturition behaviour as well as incontinence

Question 15

what is functional outflow obstruction

Answer 15

• reflex dyssynergia
• initiation of detrusor reflex with contraction of the urethral sphincter
• animal will try to pee but cant
• no block in the urinary tract
• needs drugs to decrease urethral tone

Question 16

sphincter mechanism incontince is most common in

Answer 16

• more common in femalse rather than males
• common in large/giant breeds (females)
• common in spayed females
• due to short urethra and hormonal changes
• treat with adrenergic agonists (phenylpropanolamine) or oestrogens

Question 17

secondary detrusor muscle atony is due to

Answer 17

• stretch injury
• often iatrogenic mismanagement of another condition
• bladder fills beyond capacity to stretch, damaging detrusor muscles so they can no longer contract

Question 18

what is urge incontinence

Answer 18

micturition reflex at low volume in bladder = frequent urination
usually due to bladder mucosa irritation from UTI

Question 19

tail stretch injuries in cats are challenging due to

Answer 19

bladder atony as tail is stretched leading to sacral +/- coccygeal avulsion. nerves pulled out or damaged leading to absence of function.
if nerves just stretched, may recover with time but will never regain function if torn or severed