Urinary incontinence Flashcards
How does a spinal cord transection above T12 affect sensation of the bladder?
No sensation of bladder
because sensory nerve fibres running up to brain have been transected
How does a spinal cord transection above T12 affect the external urethral sphincter?
Constantly relaxed
because somatic nerve fibres running down the spinal cord have been transected
How does a spinal cord transection above T12 affect the micturition reflex?
Over functioning
because parasympathetic nerve fibres below are still intact
and they have lost their inhibitory nerve fibres
micturition reflex occurs after small filling and stretch of bladder
How does a spinal cord transection below T12 affect the sensation of the bladder?
No sensation of bladder
because sensory nerve fibres running up to brain have been transected
How does a spinal cord transection below T12 affect the micturition reflex?
Stops functioning
because parasympathetic fibres have been transected
What is a lower urinary tract symptom?
Clinical symptoms to do with the bladder, urethral sphincters, urethra
and in men, the prostate gland
What are the different types of lower urinary tract symptoms?
Symptoms to do with
- storage of urine
- micturition
- post-micturition
What are the lower urinary tract symptoms to do with storage of urine?
Frequency of urination
Urgency of urination
Incontinence
What are the lower urinary tract symptoms to do with micturition?
Slow stream
Spraying
Intermittency
Hesitancy
What are the lower urinary tract symptoms to do with
Post-micturition dribble
Feeling of incomplete emptying
What is urinary incontinence?
Involuntary leakage of urine
What are the types of urinary incontinence?
Stress
Urge
Mixed
What is stress urinary incontinence?
Involuntary leakage of urine on exertion e.g. sneezing or coughing
What is urge urinary incontinence?
Involuntary leakage of urine with proceeding urgency of urination
What is mixed urinary incontinence?
Both stress and urge urinary incontinence
What are the different types of urinary incontinence in order of how common they are?
Stress
Mixed
Urge
What are the risk factors of urinary incontinence?
Age
Obesity
Pregnancy and childbirth
Pelvic surgery
How does obesity increase risk of urinary incontinence?
Increases intra-abdominal pressure
What is overactive bladder?
Frequent urge to urinate
How does overactive bladder relate to incontinence?
Urge urinary incontinence and mixed urinary incontinence are combinations of both overactive bladder and urinary incontinence
Is overactive bladder or urinary incontinence more common?
Overactive bladder
What drugs are given to treat stress urinary inconctinence?
Duloxetine
How does duloxetine work?
Inhibits uptake of noradrenaline by neurone endings
How does duloxetine treat stress urinary incontinence?
Increases activity of external urethral sphincter during filling phase
What drugs are given to treat urge urinary incontinence?
Anticholinergics e.g. oxybutynin
B3 adrenoceptor agonist e.g. mirabegron
How do anticholinergics treat urge urinary incontinence?
Reduce parasympathetic stimulation of bladder detrusor muscle
reduce contraction of bladder detrusor muscle
How do B3 adrenoceptor agonists treat urge urinary incontinence?
Mimic sympathetic stimulation of bladder detrusor muscle
increase relaxation of bladder detrusor muscle
What are the side effects of anticholinergics?
Act on muscarinic receptors elsewhere in the body
e.g. M1,M3 in salivary glands, gives dry mouth
M2 in heart, gives increased heart rate
