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Endo/Repro: Week 4 > Nordin: Urge Incontinence and Pelvic Organ Prolapse > Flashcards

Nordin: Urge Incontinence and Pelvic Organ Prolapse Flashcards

1
Q

What is incontinence?

A

involuntary loss of urine

may affect 30-40% of women

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2
Q

leakage of small amounts of urine when intraabdominal pressure is increased

A

Stress incontinence

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3
Q

receptors in bladder dome

A

beta adrenergic

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4
Q

receptors in trigone and urethral smooth muscle

A

alpha 1

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5
Q

receptors in deep layers of bladder

A

muscarinic

parasympathetics are involved w/ emptying

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6
Q

internal sphincter

A

involuntary alpha 1 receptors

smooth muscle

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7
Q

external sphincter

A

skeletal muscle supplied by pudendal nerve
voluntary control
somatic receptors

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8
Q

urethral sphincter smooth muscle

A

contains alpha 1 recetpors

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9
Q

how does estrogen affect urethral function?

A

less vascular/thinned w/ decreased levels

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10
Q

Sympathetics (T10-L2)

A

STORAGE
IUS- CLOSE
Bladder dome- RELAX

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11
Q

Somatics

A

alpha motor neurons in ventral horn

EUS- OPEN (voluntary)

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12
Q

Parasympathetics

A

bladder musculature

EMPTY

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13
Q

How do you empty the bladder?

A

Cholinergic muscarinic receptor agonists stimulate receptors on the detrusor muscle> contraction

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14
Q

M2/M3

A

bladder smooth muscle

Salivary glands–dry mouth

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15
Q

Activating M3 receptors

A

smooth muscle contraction

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16
Q

activating M2 receptors

A

inhibits bladder relaxation

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17
Q

B2/B3 adrenergic stimulation

A

relaxation of detrusor muscles

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18
Q

increase urethral resistance

A

Alpha adrenergic agonists

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19
Q

block urethral contraction

A

alpha antagonists

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20
Q

What is the mechanism of urine storage?

A

distension of bladder>
sympathetics>
B3 relax detrusor muscle>
A1 closure of urethral outlet smooth muscle

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21
Q

How can a cough or sneeze make you pee a bit?

A

Sudden increase in bladder pressure (cough/sneeze)>
activate somatics>
open external urethral sphincter

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22
Q

Somatic micturition reflex

A

fluid flow in urethra> initiates bladder contraction>

by way of pudendal nerve and sacral spinal cord

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23
Q

spinal vesicovesical micturition reflex

A

triggered by noxious stimuli>

bladder contraction

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24
Q

What causes reflex urination/incontinence problems?

A

damage to micturition loops

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25
Meds that affect continence...
1. diuretics 2. caffeine 3. Anticholinergics--> retention/overflow 4. alcohol> irritates bladder
26
leakage of small amounts of urine when intraabdominal pressure is increased (coughing, laughing, exercise)
Stress incontinence
27
leakage of large amounts of urine occurring shortly after a sudden urge to urinate mediated by bladder muscle contraction
Urge incontinence
28
Stress incontinence
Muscles that normally keep urethra closed are prevented from squeezing as tightly as they should d/t : pelvic floor weakness loss of elasticity CT/hormones affecting urethral sphincter
29
Urge
Inappropriate bladder contractions: PVC of bladder (hypersensitive and always contraction) anormal nerve signals
30
blockage of outlet or weak bladder muscle fxn> frequent/constant dribbing
overflow common in men with prostate enlargement
31
urination due to inability to get to a bathroom either from mobility issues, obstacles, communication/cognitive problem
Functional bladder normal but person can't get to bathroom!
32
Temporary condition causing incontinence such as medication, infection, illness
``` DIAPERS delerium infection atrophic vaginitis (lack of estrogen) drugs psychological disorders excessive urine output reduced mobility stool impaction ```
33
Cough, laugh, sneeze, lift, exercise > intrabdominal pressure exceeds urethral closing pressure> SMALL AMOUNTS
stress urinary incontinence
34
What are RF for stress urinary incontinence?
``` age pregnancy childbirth menopause (estrogen) obesity (increased pressure) chronic coughing (increased abdominal pressure, cough, smoking, constipation, occupation w/ lifting) urethral tone ```
35
Involuntary leakage preceded by sudden urge to urinate d/t involuntary bladder contractions (Bladder can be full or not)> Typically leak LARGER amounts of urine than with stress incontinence, but varies Also called detrusor instability, “overactive bladder”
Urge urinary incontinence
36
Specific conditions that can cause urge urinary incontinence?
Urinary tract infection Bladder stones Bladder cancer
37
MC cause of urge urinary incontinence
DETRUSOR OVERACTIVITY OR INABILITY TO SUPPRESS DETRUSOR CONTRACTIONS
38
In pts w/ mixed incontinence, how do you treat them?
rule out most bothersome sx
39
Weak bladder muscle (detrusor) or outlet obstruction> overdistension of bladder> dribbling/stress incontinence
Overflow
40
What medications may cause overflow incontinence?
anticholinergics beta agonists alpha agonists
41
How do you tx stress incontinence?
Weight loss if obese, fluid reduction, caffeine reduction, smoking cessation (to decrease chronic cough), control of constipation pelvic floor exercises occlusive devices (pessaries)
42
What medications can be used to tx incontinence?
Estrogen (intravaginal for urethra affect) Duloxetine (more side effects) Alpha adrenergic drugs (contract urethral sphincter) (rarely used) *not used as much
43
What is a common tx for incontinence?
surgery sling procedure bulking agent into urethra
44
How do you tx urge/overactive bladder?
Bladder retraining/scheduled voiding Fluid restriction If possible, eliminate medications and agents (caffeine) that patient is taking that may worsen incontinence Pelvic Floor Muscle Exercises
45
What is the key tx for urge/overactive bladder?
Anticholinergics Beta-agonists (mirabegron) Estrogen (intravaginal, NOT systemic) Botulinum toxin injections
46
What is a kegal?
contraction of levator ani muscles
47
Pessary
holds things up and in place when there isn't enough support
48
Thickens periurethral tissue by increasing vascular engorgement
estrogen (vaginal cream or ring) systemic worsens incontinence
49
Medications for SUI?
estrogen Alpha agonists (not really used) Duloxetine ( could work for those w/ depression)
50
Meds for urge incontinence?
Anticholinergic agents (nonselective and selective) Selective have fewer side effects (dry mouth) Long acting/extended release also have fewer side effects Caution with use in frail elderly b/c can cause dementia and narrow angle glaucoma, dementia, GI obstruction, urinary retention
51
M3 selective drug
tolterodine
52
M2/M3 less selective drug
oxybutynin
53
Anticholinergics
Competitive antagonist of acetylcholine at muscarinic receptors> Relaxes bladder smooth muscle (detrusor muscle) (decreases overactivity and contraction)
54
Mirabegron
beta agonist> relaxes bladder dome and detrusor *risk of urinary retention, esp if combined w/ anticholinergics
55
botulinum toxin
used for urge incontinence
56
Bladder training
helps pt establish control over bladder may take 1-3 mos to improve
57
pelvic organ prolapse
Movement of pelvic organs (uterus, bladder) from normal position downward toward or through the vaginal opening
58
cystocele
bladder through opening
59
rectocele
bladder through opening
60
enterocele
intestines coming out
61
What are sxs of POP?
Many patients asymptomatic! Bulge symptoms: bulge/protrusion, heaviness or pressure Urinary symptoms: Incontinence, frequency, urgency, weak stream, incomplete emptying, need to change position to void Bowel sxs Sexual sxs Pain
62
What are general RF for POP?
``` age menopause obseity anything that increases intra abdominal pressure (chronic cough, constipation, repeated heavy lifting) Pregnancy previous hysterectomy ```
63
What is treatment for POP?
Observation Pelvic Floor Muscle Exercises Pessary use (especially in elderly) Surgery

Endo/Repro: Week 4 (14 decks)

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