Urinary incontinence Flashcards
Urinary Incontience
What type of nervous supply do the ureters receive?
autonomic
Urinary Incontience
What type of nerve supply does the bladder have?
autonomic
Urinary Incontience
Describe the muscle types and of the two sphincters in the urethra. (female)
internal urethral sphincter -> thickening of detrusor muscle, smooth muscle, involuntary control
external urethral orifice -> skeletal muscle, voluntary control
Urinary Incontience
define normal miturition
the intermittent voiding of urine stored in the bladder
Urinary Incontience
What are the two phases of micturition?
filling
voiding
Urinary Incontience
Expand on the processes of the filling and voiding phases of miturition.
Filling:
- bladder fills and distends without rise in intravesical pressure
- urethral sphincter contracts and closes urethra
Voiding:
- bladder contracts and expels urine
- urethral sphincter relaxes and urethra opens
Urinary Incontience
Compare adult and infant micturition
infants: local spinal reflex (bladder empties of reaching critical pressure)
adults: voiding can be initiated or inhibited by higher centre control of the external urethral sphincter
Urinary Incontience
What receptors are stimulated as the bladder fills? What spinal nerves do these correspond to? What do these spinal nerve release to bind to the receptors in the bladder?
M3 receptors
parasympathetic S2-4
ACh
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What happens when the M3 receptors of the bladder become stretched and stimulated?
contraction of detrusor muscle for urination
Urinary Incontience
How do the parasympathetic nerve fibres work on the internal urethral sphincter while the detrusor muscle contracts?
inhibit internal urethral sphincter -> relaxation -> bladder empties
Urinary Incontience
Once the bladder empties and the stretch fibres of the bladder become inactivated, ______ nervous system (T__- L__) is stimulated by to activate the ____ receptors with _____, causing _____ of the detrusor muscle so that the bladder can fill again
sympathetic
T11-L2
beta 3 receptors
noradrenaline
relaxation
Urinary Incontience
Define stress urinary incontinence.
complaint of involuntary leakage on effort or exertion, or on sneezing or coughing
Urinary Incontience
Is stress urinary incontinence common?
yes
up to 40% of women experience
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What are some common causes of stress urinary incontinence?
- Sphincter deficiency
- Urethral hypermobility
- Prostatectomy in men
- Pelvic weakness
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Name some risk factors for stress urinary incontinence.
- Pregnancy/childbirth.
- Age/menopause.
- Obesity.
- Constipation.
- Pelvic organ prolapse.
- Chronic cough/smoking.
- Excessive weight lifting.
Urinary Incontience
Which investigations should be carried out with pts who have stress urinary incontinence?
- Urine dipsticks and cultures (exclude any infection)
- Creatinine and blood urea nitrogen (BUN) (assess kidney function)
- pad test (amount of urine leaked can be quantified)
A full neurological, vaginal and rectal examination should also be carried out to detect any possible cause for the incontinence e.g. prolapse.
Urinary Incontience
What is the pathology of stress urinary incontinence?
impaired bladder and urethral support and impaired urethral closure
Urinary Incontience
Define overactive bladder (urge urinary incontinence).
urinary urgency with urinary frequency and nocturia with or without urgency urinary incontinence
Urinary Incontience
How can we investigate for stress urinary incontinence?
history + examination (demonstrable loss of urine on examination)
urodynamics (urinary leakage during an increase in intrabdominal pressure in the absence of a detrusor contraction
Urinary Incontience
How can we manage stress urinary incontinence (conservatively)?
lifestyle: losing weight, reducing caffeine intake and stopping smoking
physio with PFE
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How can we manage stress urinary incontinence (prescribing)?
- alpha-adrenergic agonists
- oestrogen (topically in postmenopausal women with vaginal atrophy)
- tricyclic anti-depressants
Urinary Incontience
How can we manage stress urinary incontinence (surgically)?
surgical:
- mid-urethral sling or colposuspension (these 2 to reduce mobility of urethra)
- periurethral bulking agents (if we believe sphincter not working properly)
Urinary Incontience
Explain urodynamics. How can we use it to diagnose urinary stress incontinence?
24 hr test
- urinary catheter is inserted into bladder with a thin pressure line next to it with another thin pressure line in the rectum
- measurements of bladder pressures and indirect abdominal pressures.
- ask patient to cough and you will see a rise in intrabdominal pressure, but no contraction of detrusor associated with urinary leakage
Urinary Incontience
Name some risk factors of urge urinary incontinence
age
prolapse
increased BMI
bladder irritants (caffeine, nicotine)
