Urinary Incontinence Flashcards
Sympathetic nerve supply to bladder
-hypogastric nerve -T12-L2 -storage
Parasympathetic nerve supply to bladder
-pelvic nerve -S2-S4 -voiding
Somatic nerve supply to bladder
-pudendal nerve -S2-S4 -voluntary
Bladder filling
-Accommodate increasing volume at constantly low pressure -Inhibition of contractions by giving rise to gradual awareness of filling
Cortical activity during bladder filling
-Activating a reciprocal guarding reflex by Rhabdosphincter contraction; increase sphincter contraction & resistance -Activates Sympathetic pathway -Reciprocal inhibition of the Parasympathetic pathway -Mediates contraction of bladder base and proximal urethra
Bladder Emptying
-Detrusor contraction -Urethral Relaxation -Sphincter co-ordination -Absence of Obstruction or anatomical shunts (Cystocele, Diverticulum)
Cortical activity during bladder emptying
Cortical Influence (Pontine micturition centre) - Activation of parasympathetic pathway and Inhibition of Sympathetic pathway
Urinary incontinence (UI)
Any involuntary leakage of urine.
Stress urinary incontinence (SUI)
Involuntary leakage on effort or exertion, on sneezing or coughing.
Urge urninary incontinence (UUI)
Involuntary leakage accompanied by or immediately preceded by urgency.
Impact or uirinary incontinence
-UI may significantly impair the QoL -Reduce social relationships and activities -Impair emotional and psychological well- being -Impair sexual relationships -Embarrassment and diminished self- esteem
Risk factors for unrinary incontinence
-pregnancy and childbirth -pelvic floor trauma -increasing age -menopause -smoking -denervation -connective tissue disorder -increased intra-abdominal pressure -surgery
Patient assessment history
-age -parity -mode of deliveries -weight of heaviest baby -Smoking -HRT -Previous PFMT, Surgical treatment of SUI or POP
Patient assessment - irritation symtoms
-Urgency ; Sudden compelling desire to void that is difficult to defer -Increased daytime frequency (>7) -Nocturia (>1) -Dysuria -Haematuria
Patient assessment - incontinence symtoms
-Stress UI -Urgency UI -Coital Incontinence -Severity: How many pads/ day?
Patient assessment - voiding symptoms
-Straining to void -Interrupted flow -Recurrent UTI
Prolapse Symptoms
-Vaginal Lump/ Dragging sensation in vagina
Bowel symptoms
-Faecal Incontinence -Constipation -Faecal evacuation dysfunction -IBS
Patient assessment - tracking and tests
-3 days Urinary Diary : -Fluid intake: Quantity & Quality -Urine Out-Put (exclude Nocturnal Polyuria) -Daytime Frequency -Nocturia -Average voided volume -Urine dipstick
Examination of the women with bladder/ pelvic floor problems
-Prolapse -Stress incontinence -Uro-genital atrophy changes -Pelvic mass (space occupying leasion) -Pelvic floor tone, strength, awareness
Investigations for SUI
-Urinalysis: Multistix +/- MSSU -Post voiding residual volume assessment (usually by bladder scanning) only If symptoms of voiding difficulties -Urodynamics: ONLY indicated if surgical treatment is contemplated
Management options for SUI
-Lifestyle changes -Medical treatments -Physiotherapy -Surgery
Lifestyle changes for SUI
-Stop smoking -Lose weight -Eat more healthily to avoid constipation -Stop drinking alcohol and caffeine
Pelvic floor muscle training
-reinforcement of cortical awareness of muscle groups -hypertrophy of existing muscle fibres -general increase in muscle tone and strength
