Urinary Incontinence Flashcards
What is overflow incontinence and what are it’s causes?
Leakage of small amounts of urine from a full or overdistended bladder.
Causes:
1) impaired bladder contraction
2) a bladder outlet or lower urinary tract obstruction
What are causes of bladder outlet or lower urinary tract obstruction in overflow incontinence?
- benign prostatic hyperplasia, prostate Ca
- urethral structures
- fecal impaction compressing the urethra
- pelvic organ prolapse
What are causes of impaired detrusor muscle contraction (detrusor underactivity) in overflow incontinence?
- disorders affecting bladder innervation (diabetic neuropathy, spinal cord injury, post-stroke, nerve damage d/t GU surgery, MS)
- medicaitons such as anticholinergics which decrease bladder contractility
What are some strategies to improve bladder emptying in overflow incontinence?
- treat underlying problem
- scheduled toileting
- double voiding (make two attempts to void to improve emptying)
- Crede’s maneuver (apply pressure over the symphysis pubis and slowly pressing down is helpful in patients who have a spinal cord injury or other neurological problems
- medications = alpha-adrenergic antagonists.
What is stress incontinence?
Leaking of urine during physical activity/exercise or increase in abdominal pressure.
What are the causes of stress incontinence?
1) pelvic floor weakness
2) failure of the urethral sphincter to remain closed when abdominal pressure increases
What are causes of pelvic floor or uretheral sphincter weakness in stress incontinence?
- age related changes
- hx of vaginal deliveries
- prostatectomy (loss of urethral compression by the prostate)
- menopause (urethral sphincter weakening when estrogen levels decrease)
What are some causes of increased abdominal pressure in stress incontinence?
- obesity
- pregnancy
- high impact exercise
Why does a weak pelvic floor cause stress incontinence?
In females, the angle between the bladder and the posterior proximal urethra is important in maintaining continence.
Weakness of the pelvic floor muscles causes incontinence by obliterating the posterior urethrovesical angle.
What are some management techniques for stress incontinence?
Lifestyle:
- weight loss
- constipation management
Behavioural:
- pelvic floor strengthening
Mechanical devices:
- incontinence pessary (inserted into vagina - supports the bladder and urethra and gently compresses the urethra against the pelvic bone to prevent leakage when abdominal pressure increases.
Containment devices:
- absorbent products
Medications:
- alpha-adrenergic agonist may improve muscle tone of hte urinary tract
- HRT for postmenopausal stress incontinence
What is urge incontinence?
Leaking of urine because of an inability to delay voiding after a sudden sensation of bladder fullness or desire to void. The patient is aware of hte need to void, but is unable to reach a toilet in time.
Sometimes called overactive bladder (OAB), but someone can have an OAB with or without incontinence.
What are the causes of urge incontinence?
Detrusor muscle overactivity d/t:
1) bladder irritation which increases the sensitivity of nerves that sense bladder filling
2) loss of inhibitory control (uninhibited bladder contraction) - detrusor muscle contracts involuntarily during bladder filling.
What are some causes of bladder irritation in urge incontinence?
- UTI (cystitis)
- bladder stones
- prostatitis
- pelvic radiation therapy
- atrophic urethritis or vaginits
What causes loss of inhibitory control in urge incontinence?
- damage to the CNS inhibitory pathways (post-stroke, dementia, parkinson disease)
NOTE: the cerbral cortex has an inhibitory effect on micturition. Thus, damage causing urge incontinence tends to be related to nuerological conditions affecting the cerbral cortex
What is micturition?
The action of urinating.
