Urinary Incontinence Flashcards
define incontinence
involuntary micturition
define compliance of the bladder
normally the vesico-elastic proeprties of teh bladder allow it to store increasing volumes of urine with little change in bladder pressure until capacity is reached
what does a cysometrogram measure
- cystometry measures the contractile force of the bladder when voiding
- generates a cystometrogram which plots volume of liquid emptied from the bladder agaisnt intravesical pressure
describe what happens during normal voiding
- emptying of bladder results in a bell shaped curve on uroflowmetry with a rise to peak amplitude
- following voiding, bladder pressure decreases rapidly, pelvic floor muscles contract and the bladder neck closes
how may compliance lead to incontinence
poor compliance means significant increase in bladder pressure with small increases in bladder volume - may lead to incontinence
what happens to bladder compliance with dialysis
- bladder compliance decreases the longer the duration fo dialysis continues
how would bladder outlet obstruction be indicated on a cystometrogram
high voiding detrusor pressure with a low flow rate
define urge incontinence
- involuntary leakage accompanied by, or immediately preceding urgency
- often described as the complaint of a sudden compelling desire to pass urine, which is difficult to defer
how does urge incontinence present
daytime frequncy, small voided volumes, urgency (may be triggered), enuresis
causes of urge incontinence
phasic increases in detrusor muscle (over activity):
- This can be due to central inhibitory pathway malfunction (e.g. paraplegia) or sensitisation of the peripheral afferent terminals in the bladder
- Destruction of sacral nerves
- Pelvic surgery/fracture can damage sacral nerves
- Can be a bladder muscle problem
- Neurological: DM, MS and Parkinson’s damage nerves involved in the micturition reflex
- Infection/stones/cancer can irritate the bladder and stimulate afferent nerves
- Constipation can stimulate the nerves
- Idiopathic
what diseases can damage the nerves involved in the micturition reflex and cause urge incontinence
DM, MS, Parkinsons
what is bladder dysfunction characterised by
asynchronous detrusor contractions and inhibition of voiding
treatment of urge incontinence
- dietary discretion
- biofeedback
- drugs
- botulinum toxin
- neuromodulation (bladder pacemaker)
- surgery
what does biofeedback involve
learning to control the urge to urinate
what drugs are used for urge incontinence
- anti-muscarinics eg oxybutynin and tolterodine
- bladder voiding involves stimulation of the muscarinic receptors of the detrusor muscle by ACh
- there is some negative effect on detrusor contraction
- but improve frequency and urgency
- beta 3 adrenergics (eg mirabegron) are 2nd line
what surgery is indicated for urge incontinence
enterocystoplasty
stress incontinence
- increased abdominal pressure that overwhelms sphincter muscles without detrusor contraction
- eg cough, sneeze, laugh
causes of stress incontinence
- damage to pelvic floro or urethral function eg childbirth
- incompetent sphincter eg old age and obesity
typical history of stress incontinence
loss of small but infrequent amounts of urine on coughing etc
how does pregnancy cause stress incontinence
child puts pressure on bladder
treatment of stress incontinence
- weight loss and smoking cessation
- pelvic floor exercises strengthen external sphincter muscles - Kegel exercises
- drugs - limited role
- surgical correction
what drugs are used for the management of stress incontinence
duloxetine and norephinephrine
surgical correction of stress incontinence
tension free vaginal tape to support the urethra
name 2 ways to record urine at home
- frequency volume chart records the volume voided as wll as the time of each micturition for at least 24 hours
- bladder diary
