Renal and Bladder Flashcards
the bladder holds urine by inhibiting the _______ system
parasympathetic
What is stress incontinence
Urinary leakage that occurs from increased intraabdominal pressure (laughing, coughing, sneezing) in combination with a weakened pelvic floor.
Treatment for stress incontinence
Treatment is mostly NOT pharmacologic for this type of incontinence and typically includes pelvic floor strengthen exercises (Kegals), regular use of diapers/pads, pessary devices (a rigid ring inserted into the vaginal canal to support pelvic organs that have prolapsed or relaxed, restoring tone to the pelvic floor) and/or surgeries.
What is overflow incontinence
A frequent and sometimes steady dribble of urine from a distended bladder that is unable to completely empty during planned voids
Cause of overflow incontinence
obstructive pathology but can also be caused by injury to the parasympathetic nervous system.
Obstructive - like BPH
Nervous - systemic diseases that negatively affect peripheral nerves (i.e. diabetes, alcoholism, B12 deficiencies) to spinal cord pathologies such as multiple sclerosis or trauma
Treatment for overflow incontinence
Catheter is placed until cause is found
Pharmacologic agents can then be used (like for BPH)
What is urge incontinence
sudden and unexpected need to urinate secondary to bladder spasms or detrusor overactivity before the bladder is full.
Causes of urge incontinence
Damage or dysregulation of the parasympathetic nervous system.
This type of incontinence can occur after any insult to the nervous system whether it be supraspinally located such as stroke or Parkinson’s, spinally located such as spinal cord trauma or multiple sclerosis or peripheral nerve located such as diabetes mellitus, herpes zoster, herniated disc or from local nerve damage after surgery.
How do antimuscarinic medications work
By antagonizing the acetylcholine receptors of the urothelium, detrusor muscles and afferent nerves of the ureters and bladder wall
3 major antimuscarinic medications
Oxybutynin
Darifenacin and solifenacin (more selective for M3)
Side effects of antimuscarinics
Looks like a blocked parasympathetic system
In terms of the cardiovascular system, patients may experience arrhythmias, hypertension and palpatations. The GI system may respond to these drugs with constipation and cramping. Some patients may experience difficulty reading secondary to blurry vision.
Secondary treatment for urge incontinence that is not an antimuscarinic
intrabladder injection of botulinum toxin A
How does botulinim treatment work in the bladder
Botulinum toxin prevents the release of acetylcholine into the cholinergic synapse, or an indirect antagonism of the parasympathetic response in this system
What is functional incontinence
an inability to hold urine for reasons other than neurologic or lower urinary tract dysfunction, treatment is focused on treating underlying causes
What is mixed incontinence
combination of urge and stress (treated with therapies of both)
