Urinary Incontinence Flashcards
Urinary incontinenece
Failure of voluntary control of the bladder and urethra sphincters, with constant or frequent involuntary passage of urine
Other terms for incontinence
- enuresis
- inappropriate urination
- nocturia
Components of the bladder
- external sphincter: skeletal muscle, pudendal
- internal sphincter: smooth muscle, hypogastric
- bladder: detrusor muscle, pelvic
Micturition phase
Contraction of detrusor muscle, relaxation of urethral sphincters
- parasympathetic
Storage phase
Relaxation of detrusor muscle, contraction of urethral sphincters
- sympathetic
Causes of urinary incontinence
- stress incontinence (impairment of urethral sphincter)
- overflow incontinence
- urge incontinence
Normal micturition phase with abnormal storage phase
Stress incontinence
Causes of stress incontinence
- primary urethral sphincter incompetence
- hormone responsive incontinence
- ectopic ureters
- damage to pudendal innervation
- mechanical disruption of sphincter
- anatomic abnormalities
Abnormal micturition phase, abnormal storage phase
Overflow incontinence
- abnormal micturition: dysruia/stranguria, increased residual volume
- abnormal storage: overdistended bladder, overflow incontinence
Causes of overflow incontinence
- reflex dyssnergia
- detrusor atony
- partial urethral obstruction
Causes of partial urethral obstruction
- prostatic disease
- urethral calculi
- urethral neoplasia
- urethritis
Abnormal micturition phase, abnormal storage phase
Urge incontinence
- micturition: dysuria/stranguria, pollakiuria
- storage: very small bladder, palpation can trigger urination
Causes of urge incontinence
- cystitis and urethritis (bacterial, sterile)
- cystic calculi
- bladder tumors
_____ worsens incontinence
Bacterial cystitis
- incontinence may predispose to bacterial cystitis
______ increases urine volume
PU/PD
- fuller night-time bladder worsens enuresis
Chronic renal failure causes _____
Dilute urine
Diagnostic tests for incontinence
- observe urination
- residual volume
- urine analysis
Further investigation may include
- hematology/biochemistry
- radiography
- ultrasonography
- vaginourethroscopy
Major causes of incontinence
- hormone responsive incontinence
- primary urethral sphincter incompetence
- ectopic ureters
Hormone responsive incontinence
Estrogen responsive incontinence is common cause of incontinence in older dogs
- estrogens enhance function of alpha-adrenergic receptors in internal urethral sphincter
Hormone-responsive incontinence could be ______
Multifactorial
- obesity
- UTI
- short urethra
- PU/PD
Hormone-responsive incontinence treatment
- estrogens
- testosterone (male)
- alpha adrenergic agonists
- surgery
- endoscopic procedures
Primary urethral sphincter incompetence only occurs in ______
Puppies
- resembles hormone responsive incontinence
