Urinary incontinence Flashcards
Epidemiology of urinary incontinence (4)
+with age
+in women
+aged care facilities
+dementia/cognitive impairment
Impact on health (4)
Morbidity->perineal infections, falls
Sexual dysfunction
QOL->anxiety, embarrassment, depression, social, work
Increased caregiver burden
Risk factors
Strong: \+Age \+Parity, vaginal delivery, episiotomy Obesity LUTS Care facility Dementia Constipation Fecal incontinence High impact physical activity Pelvic organ prolapse Stroke, parkinson's, MS Diuretic use Caffeine
Types (3)
Stress
Urge
Overflow
Fistula
Definition and mechanism of stress incontinence
Def: involuntary leakage of urine on effort/exertion
M: Urethral hypermobility + intrinsic sphincteric deficiency
Definition of urge incontinence
Involuntary leakage of urine w/ immediate/preceeding urgency
What are potential precursors to urinary incontinence
Burning with urination
Trouble starting urinary flow
Inability to stop urine flow
Needing to push and strain while urinating
Needing to urinate more than once to empty bladder
Nocturia are potential precursors of urinary incontinence
How does prolonged defecatory effort predispose
Progressive neuropathy
How does stroke predispose
Interruption of CNS inhibitory pathways->associated with stress, urge and overflow incontinence
Impact of forceps delivery on continence
+bladder neck descent
Explain the Delancey classification
Level 1: Upper Vertical, transverse cardinal, uterosacral supports->support of upper vagina, cervix, lower uterine segment posteriorly to sacrum
Level 2: Horizontal->ischial spine to post aspect of pubic bone. Lateral-> paravaginal fascia, The arcus tendineous fascia
pelvis and the fascia overlying the levator ani muscles provide support to the middle part of the vagina.
Level 3: Lower vertical support. The urogenital diaphragm and the perineal body provide support to the lower part of the vagina
Maintenance of continence (3)
Bladder factors:
Elastatic and inhibition of sacral plexus allows +bladder filling w/o +++pressure
Urethral factors:
Smooth/striated/elastic, blood vessel turgus (submucosal vascular plexus), mucosal folds, +resting tone of the urethra
Pressure transmission factors:
+intra-abdominal pressure= +pressure to bladder neck and proximal urethral->active contraction of urethral striated muscle and levator complex maintains continence
Micturition physiology of storage
Pontine micturition centre
Storage->contraction of sphincters, relaxation of bladder. Somatic to external, sympathetic to internal. Pudendal +external (supported by lateral vaginal wall by levator ani/fascia and ligaments). Involuntary/voluntary input +outflow resistance maintaining continence. SM vascular plexus +urethral turgor->sustaining closure of urethral sphincter.
Micturition physiology of voiding
Urethral sphincter relaxation and bladder contraction. PNS->S2-4 traveling through hypogastric nerves. ACh->Muscarinic receptors 2 and 3->detrusor muscle contraction= urinary flow through relaxed urethra.
Inhibition of voiding
Pontine storage centre. Afferents from distended bladder->T11 - L2 sympathetic->NE B receptor on bladder wall, alpha at bladder neck and urethra. Inhibits detrusor, and +sphincter. Inhibits.
Brief difference in pathophysiology of urge incontinence and stress incontinence
Urge->defect on coordination of micturition->neurogenic, myogenic
Stress->anatomical defect
Definition of over-active bladder
Urgency w/ or w/o urge incontinence, usually w/ frequency and nocturia in absence of underlying metabolic/pathalogic condition
Reversible causes of urinary incontinence
DIAPPERS Delirium Infection Atrophic vaginitis Pharmacologic causes Psychiatric causes Excessive urine production Restricted mobility Stool impaction