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Pelvic Health- Continence/Incontinence Flashcards

1
Q

what is involved in the genitourinary system?

A
  • upper urinary tract (kidneys & ureters)
  • lower urinary tract (bladder * urethra)
  • pelvic floor muscles
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2
Q

how much fluid can the kidneys filter?

A
  • 200 quarts of fluid
  • 2 quarts excreted
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3
Q

why are the kidneys at an increased risk of cancer?

A

they are exposed to carcinogens for prolonged periods of time

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4
Q

blood flow to kidneys reduces with age which leads to (increase or decrease) efficiency and (increase or decrease) urine volume

A

decreased efficiency & increased urine volume

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5
Q

how much fluid can the bladder store during day & at night?

A
  • daytime storage: 2 cups of fluid
  • nighttime storage: 4 cups of fluid
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6
Q

increased nocturia occurs at what age?

A

> 60 y/o

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7
Q

is the urethra shorter in male or females?

A
  • shorter in females
  • increase infection rate
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8
Q

what are the levator ani muscles? which control defecation and which support pelvic viscera?

A
  • pubococcygeus
  • puborectalis
  • pubovaginalis
  • illiococcygeus
  • ischiococcygeus
  • pubococcygeus & puborectalis control defecation
  • illiococcygeus & ischiococcygeus support pelvic viscera
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9
Q

what muscles make up the outside wall of the pelvic floor deep?

A
  • piriformis
  • obturator internus
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10
Q

what are the superficial muscles of the pelvic floor? and the action of each?

A
  • bulbospongiosus: empties urethra acts as sphincter, assists with sexual function
  • ischiocavernosus: assists sexual function
  • superficial transverse perineal: stabilizes perineal body
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11
Q

what makes up the urogenital diaphragm and what is the action of each?

A
  • sphincter urethrae: controls flow of urine
  • compressor urethrae: compresses ventral wall of urethra
  • sphincter urethral vaginalis: compressed ventral wall of urethra * only in women
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12
Q

what are requirements of continence?

A
  • competent sphincter
  • adequate PFM strength
  • adequate bladder storage
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13
Q

what type of fibers does the pelvic floor muscles have?

A
  • type I muscle fibers
  • supportive: pelvic viscera
  • sphincteric: closure of excretory tracts
  • sexual: effector response
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14
Q

what controls micturition?

A
  • pons micturition center
  • frontal cortex
  • hypothalamus
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15
Q

describe anorectal function

A
  • colon transports feces through rectosigmoid ‘sphincter’
  • rectum stores feces (up to 300mL)
  • dissension of rectum triggers desire to void
  • puborectalis maintains optimal angle of rectum to facilitate defecation
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16
Q

what is the neurophysiology of the genitourinary system in regards to sexual response?

A
  • rhythmic contractions contribute to achievement of orgasm
  • PFM activation decrease venous outflow causing increase blood to penis/clitoris
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17
Q

what is continence?

A
  • response to changes in abdominal pressure
  • urethral constriction by mm of urethral wall
  • urethral stabilization by pelvic floor
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18
Q

what is continence determined by?

A

maximum urethral closure pressure at rest & during increase in pressure

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19
Q

continence is maintained when?

A

urethral pressure > bladder pressure

20
Q

what is bladder volume conscious awareness?

A

8-12 oz which increases internal bladder pressure

21
Q

what is the daytime and nighttime capacity of a healthy bladder?

A
  • daytime: 16 oz (400mls)
  • nighttime: 32 oz (800mls)
22
Q

what are some ways to measure bladder volume?

A
  • container method
  • weight of absorbent products
  • catheter bag
23
Q

what are some age related changes to bladder capacity?

A
  • diminished capacity
  • increased residual urine
  • uninhibited bladder contractions (OAB = detrusor hyperreflexia)
  • delayed sensation to urinate
24
Q

what is a normal bowel schedule?

A

1-3 times per day up to once every 3 days

25
how does fecal continence occur?
- pressure based system (basal resting pressure) - external anal sphincter & puborectalis mm relaxation cause opening of anal canal
26
what are some things anal continence depend on?
- anal sphincter - pelvic floor dysfunction - rectal distensibility - anorectal sensation - intact nervous system - mental function - stool volume - stool consistency - colonic transit
27
what is incontinence?
- amount leakage - type of leakage - leakage of a certain frequency - leakage which is considered to be social or hygienic problem
28
what is the prevalence of incontinence: - women or men - institutional setting or independent setting - old or middle age
- women > men - institutional setting > independent setting - old > middle age
29
what are some causes of incontinence in women?
- weak bladder muscles - overactive bladder - weak pelvic floor - damage to nerves controlling pelvic floor - other diseases limiting mobility - pelvic organ prolapse
30
what are some causes of incontinence in men?
- prostatitis - damage to nerves controlling pelvic floor - benign prostate hyperplasia
31
what are some filling or irritative symptoms of incontinence in males?
- frequency - urgency - urgency incontinence - nocturia
32
what are some obstructive or voiding symptoms of incontinence in males?
- hesitancy - weak stream - straining - incomplete emptying - intermittency - terminal & post-void dribble
33
what is stress incontinence?
- involuntary loss of urine during physical exertion - unable to overcome increase in intraabdominal pressure (coughing, laughing, exercise, obesity)
34
what are some causes of stress incontinence?
- weakness & laxity of pelvic floor musculature - post partum or menopause can cause this
35
what is urge incontinence?
- detrusor muscle contraction occurs - sensation of bladder fullness perceived after leakage occurs
36
what are some causes of urge incontinence?
- poor training of the bladder - precipitated by behavior or activity
37
what is mixed incontinence?
combination of stress & urge symptoms
38
what is functional incontinence?
leakage due to inability or unwillingness to toilet due to: - impaired cognition (dementia) - depression - impaired physical function (mobility/dexterity) - environmental barriers
39
what is overflow incontinence?
- urinary retention (over distention) - decreased or lacking urge - continuous leaking of bladder or incomplete voiding
40
what are some caused of overflow incontinence?
- anatomical obstruction (prostate enlargement) - neurogenic bladder (MS or spinal lesions)
41
what is the clinical diagnosis of over active bladder (OAB)?
- urinary urgency - urinary frequency - nocturia - urgency urinary incontinence
42
what are the symptoms of overactive bladder?
- feel a sudden urge to urinate that's hard to control - lose urine without meaning to after an urgent need to urinate, called urgency incontinence - urinate often (>8 time in 24 hrs) - wake up more than twice a night to urinate
43
what is anal incontinence?
voluntary loss of feces or flatulence
44
what is urgency anal incontinence?
- involuntary but recognized - passage of gas, liquid or solid stool
45
what is passive anal incontinence?
- unrecognized - leakage of mucus, fluid or stool
46
what are the risk factors for urinary incontinence?
- increase BMI - age - pregnancy/multiple gestation, childbirth, epstiotomy, large gestational weight - cysteocele or uterine prolapse - diabetes - depression - constipation, fecal impaction - bladder irritation - loss of ADL skills (decreased mobility) - impaired cognition function - neurologic disorders - psychogenic disorders - high impact exercise - tobacco use - recurrent UTI
47
what are some differential diagnoses that mimic incontinence?
- medication adverse effect - nocturnal polyuria - polydipsia - diabetes insipidus - interstitial cystitis/bladder pain syndorme - neurological disease - fecal motility disorders - chronic pelvic pain - history of chronic UTIs - gross hematuria - prior pelvic/vaginal surgery - pelvic cancer - pelvic radiation

Health Promotion (1 decks)

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