Tuesday - ILT - incotinence Flashcards
Why might people not seek help for incontinence
embarrassment
unaware there is treatment
what muscle holds the bladder up
levator ani
what receptor are on the bladder dome
in the trigone?
deep layer?
beta (for relaxation)
alpha-1 also on smooth muscle (alpha agonists help tighten the sphincter)
muscarinic - acetylcholine from parasympathetics contracts bladder for emptying
voluntary control is from what nerve
pudendal –> external urethral sphincter
Detrusor muscle muscarinic activity
cholinergic receptor agonists make you pee
M3 –> smooth muscle contraction
M2 –> inhibits bladder relaxation
m3 makes you pee
Adrenergic activity on detrusor muscle
beta 2 and beta3 –> relaxation of detrusor muscle
alpha1 –> agonists –> increase urethral resistance
antagonists –> block urethral contraction
storage in bladder causes what
distention –> relaxation of detrusor (beta 3)
promotes urethral closing (alpha 1)
Overflow incontinence
either blockage or weak bladder
frequent and constant dribbling
BPH
Functional incontinence
can’t get to bathroom bc they’re dumb or old or both
Infections/neoplasms that cause incontinence
UTI
Bladder stone
bladder cancer
test to see if there’s a blockage in outflow
post void residual - via ultrasound
if there’s a blockage, or weak detrusor, there’s more left over
what urologists do to assess bladder
cystometics
- determine if it’s stress or urge
Tx for stress incontinenece
weight loss, fluid reduction, stop caffeine, stop smoking, control constipation
pelvic floor exercises
pesseries
Tx for overactive bladder
scheduled voiding
eliminate meds that could couse it
meds
- anticholinergics
- beta agonist mirabegron
- estrogen intravaginally (thickens tissue)
Tx for urge incontinence
anticholinergics
nonselective - oxybutynin
selective - darifenacin and solifenacin
- more cost but less side effects (just M2)
