Urinary incontinence Flashcards
which 2 factors ensure the bladder maintains continence as it fills
- Intravesical pressure remains low as a result of stretching of the bladder muscle (detrusor) which does not contract involuntarily
- the sphincter mechanisms of the bladder neck urethral muscles
What happens at the onset of voiding
the sphincters relax - mediated by decreased sympathetic activity
when does stress incontinence occur
as a result of sphincter weakness
small leak of urine when intra abdo pressure rises eg with coughing
stress incontinence rx
young women - pelvic floor exercises
post menopausal women - oestrogen creams
surgery - artificial sphincter
what happens in urge incontinence
strong desire to void and the pt may be unable to hold his or her urine - caused by detrusor overactivity or overactive bladder
rx urge incontinence
mild cases - bladder retraining, reduction of alcohol / caffeine, hypnotherapy & electrical stimulation
severe - botulinum toxin (botox)
overflow incontinence
men w prostatic hypertrophy causing outflow obstruction
leakage of small amounts of urine
distended bladder on abdo exam
rx overflow incontinence
urethral or suprapubic catheterisation to relieve obstruction otherwise = renal damage
neurological causes of incontinence
brainstem damage - incoordination of detrusor muscle activity and sphincter relaxation = they contract together
rx - a-adrenergic blockers
autonomic neuropathy eg in diabetes - decreases detrusor excitability = distended bladder and large residual urine = infec
causes of incontinence in old people
diuretic rx, dementia and difficulty in getting to the toilet because of immobility
neuronal control of the lower urine tract
PS (cholinergic) S3-5 drive detrusor contraction = pee
S (noradrenergic) T10-L2 urethral contraction (smooth muscle component but the main part of the sphincter muscle is skeletal muscle), and inhibits detrusor contraction
