Urinary incontinence Flashcards
Upper urinary tract consists of what?
Upper tract (Kidneys & Ureters): > A low pressure distensible conduit with intrinsic peristalsis > Transport urine from nephrons via ureters to the bladder.
Lower urinary tract consists of what?
Lower tract (Bladder & Urethra):
> The bladder fills at rate of 0.5-5 mls/min
> A low-pressure storage of urine
> Efficient expulsion of urine at appropriate place & time
What is the vesico-uteric mechanism?
Vesico-ureteric mechanism: Protects the nephrons from any damage secondary to retrograde transmission of back pressure or infection from the bladder
Hypogastric nerves?
Hypogastric nerves (sympathetic) T10-L2
Allows storage in the bladder
Pelvic nerves?
Pelvic nerves (Parasympathetic) S2-4
Controls voiding
Pudendal nerves?
Pudendal nerves (Somatic) S2-4
Voluntary
What happens during bladder filling?
1) Accommodate increasing volume at constantly low pressure.
2) Inhibition of contractions by giving rise to gradual awareness of filling.
Activating a reciprocal guarding reflex by Rhabdosphincter contraction; increase sphincter contraction & resistance.
What happens to cortical activity during bladder filling?
Activating a reciprocal guarding reflex by Rhabdosphincter contraction; increase sphincter contraction & resistance.
1) Activates Sympathetic pathway &
2) Reciprocal inhibition of the Parasympathetic pathway
3) Mediates contraction of bladder base and proximal urethra.
What happens during bladder emptying?
1) Detrusor contraction.
2) Urethral Relaxation.
3) Sphincter co-ordination.
4) Absence of Obstruction or anatomical shunts (Cystocele, Diverticulum)
What happens to cortical activity during bladder emptying?
Cortical Influence (Pontine micturition centre) 1) Activation of parasympathetic pathway &
2) Inhibition of Sympathetic pathway
What is urinary incontinence (UI)?
Any involuntary leakage of urine
What is stress of urinary incontinence (SUI)?
Involuntary leakage on effort or exertion, on sneezing or coughing
What is urge urinary incontinence (UUI)?
Involuntary leakage accompanied by or immediately preceded by urgency
What is mixed urinary incontinence (MUI)
Involuntary leakage accompanied by or immediately preceded by urgency & on effort or exertion, or on sneezing or coughing
What percentage of women aged 15-60 have urinary incontinence?
15-25%
What percentage of women aged >60 have urinary incontinence?
15-40%
What percentage of women in nursing homes have urinary incontinence?
More than 50%
Impact of urinary incontinence?
1) UI may significantly impair the QoL.
2) Reduce social relationships and activities.
3) Impair emotional and psychological well- being.
4) Impair sexual relationships.
5) Embarrassment and diminished self- esteem.
Risk factors of urinary incontinence?
> Age > Parity > Menopause > Smoking > Medical problems > Intra abdo pressure > Pelvic floor trauma > Denervation > Connective tissue disease > Surgery
Childbirth = Main risk factor
What is the main risk factor of urinary incontinence?
Pregnancy and childbirth
Patient assessment in urinary incontinence - History?
> Age, parity, mode of deliveries, weight of heaviest baby, Smoking, HRT,
> Medical Conditions: DM, anti-HTN medications, Glaucoma, Heart/Kidney/Liver problems, Cognitive problems, Anti-depressants/ anti-psychotics.
> Previous PFMT, Surgical treatment of SUI or POP
Patient assessment in urinary incontinence - irritation symptoms?
Irritation Symptoms:
> Urgency ; Sudden compelling desire to void that is difficult to defer.
> Increased daytime frequency (>7)
> Nocturia (>1)
> Dysuria
> Haematuria ☻
> Fluid intake increased
Patient assessment in urinary incontinence - incontinence symptoms?
> Stress UI
> Urgency UI
> Coital Incontinence
> Severity: How many pads/ day?
Patient assessment in urinary incontinence - voiding symptoms?
Voiding Symptoms:
> Straining to void
> Interrupted flow
> Recurrent UTI ☻