Urinary Incontinence Flashcards
what is definition of urinary incontinence
complaint of any involuntary leakage of urine
what are the types of urethral incontinence
Overflow incontinence
Urge incontinence
Stress incontinence
Mixed incontinence
what can cause urine to leak extraurethral
ectopic ureter
fistula
what happens in the storage phase
Intravesical pressure is less than the urethral pressure
Urine stays in bladder
what can affect urethral pressure
abdominal pressure
what happens in the voiding phase
active contraction of the detrusor muscle - increases intravesical pressure
exceeds urethral pressure
flow occurs
co-ordinate relaxation of the bladder outlet
what spinal level is the bladder centre
S2-S3
what nerves play a part in the reflex arcs of the bladder
pelvic parasympathetic nerves
pudendal nerve
what are features of overflow incontinence
Huge palpable bladder
Chronic retention
Insensible incontinence (no signal they are going to lose control)
Often wet at night
what often causes outflow incontinence
bladder outflow obstruction
what can be a consequence of continued bladder outflow obstruction
renal failure/impairment
what is the features of urge syndrome
Frequency, small voided volumes Urgency - Provocation Enuresis Urge urinary incontinence (do not make it to the toilet on time)
how is detrusor overactivity diagnosed
urodynamics
what is detrusor overactivity
Bladder dysfunction characterised by detrusor contractions occurring during inhibition of voiding
what can irritate the bladder and cause afferent overstimulation
bladder stone
bladder tumour
what happens in paraplegia in relation to urinary incontinence
loss of central inhibition
what spinal injury causes the bladder to become an inert bad
destruction around the lumbar region, S2 and S3
what can damage the parasympathetic nerves around the bladder
pelvic surgery or fracture
what is (Urodynamic) Stress incontinence
Urine leaks during increased intra abdominal pressure, without a detrusor contraction
causes of USI
damage to pelvic floor or urethral function - childbirth
how is USI diagnosed
urodynamic diagnosis
what would be seen on Examination of an overflow urinary incontinence
Painless palpable mass arising from pelvis Cannot “get below” it Dull to percussion =bladder
Tx of overflow urinary incontinence
Assess renal function
Treat the obstruction
- Catheterise
Rehabilitate the bladder
- Teach intermittent self catheterisation
Tx of urge urinary incontinence
Dietary discretion (avoid caffeine)
Bladder retraining,
Antimuscarinics - (e.g. oxybutynin, tolterodine)
Beta 3 adrenergics (mirabegron)
Neuromodulation (“pacemaker” for the bladder)
Surgery - Enterocystoplasty
what is a Side effect of antimuscarinics
dry mouth
Tx of stress incontinence
Stop smoking! Pelvic floor exercises - physiotherapy Weight loss Surgical correction - Open procedures – colposuspension - largely replaced by: Minimally invasive “tape” procedures
what are the factors of urinary incontinence in the elderly
Immobility Dementia Drugs- diuretics, sedatives Obstruction and overflow Neuropathy Pelvic floor weakness
what is a ectopic ureter
rare, congenital
ureter is joining with urethra below bladder
when should ectopic ureter be considered
baby that cannot get out of nappies
child is developing normal but urine is leaking continuously
what is vesico-veginal fistula
vagina and bladder touching causes ischaemia
fistula is made
urine leaks out
seen in developing countries
definition of stress urinary incontinence
involuntary leakage on
effort or exertion, or on sneezing or coughing
definition of urgency
complaint of a sudden compelling desire to pass urine, which is difficult to defer
definition of urgency urinary incontinence
involuntary leakage accompanied by, or immediately preceded by urgency.
Urgency, with or without urge incontinence, usually with frequency and nocturia - what is this?
overactive bladder syndrome, or urge syndrome
