Urinary Incontinence Flashcards
How can you broadly categorise incontinence?
Neurogenic / Non-neurogenic
By presenting signs
What presenting signs can you use to categorise urinary incontinence?
Congenital - anatomical Overflow -leaking due to obstruction - Paradoxical Stress -increases in abdo pressure e.g. cough Urge - UTI Response to treatment Hormonal - sphincter mechanism
What is paradoxical incontinence ?
Overflow incontinence due to obstruction
Often when patient lies down
What are the juvenile causes of incontinence?
OFTEN ANATOMICAL
Ectopic ureters USMI Genitourinary dysplasia Bladder hypoplasia Intersex Patent urachus Neuro dz
What is USMI
Urethral sphincter mechanism incontinence
What is the most common cause of adult incontinence?
USMI
What are the causes of incontinence in adults ?
USMI Prostatic dz Neuro Urogenital neoplasia Fistulae Bladder atony Cystitis Detruser instability Pelvic masses
What dogs are more likely to get USMI?
Neutered bitches
Castrated male and entire bitches also
What urine leakage is associated with USMI?
Leakage during recumbency as increased intra-abdominal pressure
May be progressive or manifests when another condition presents e.g. PUPD increases volume in bladder
What risk factors are associated with USMI?
Neutering esp in large breeds
Breed- Irish setter, Rottie, Old English Sheepdog
Large
How do you diagnose USMI?
History
PE - unremarkable
Rule out other causes with clin path. urine, biochem
and observe response to trial tx
Diagnostic imaging if no response
How can you treat USMI?
Treat UTI
Treat systemic dz
Diet if obese
Medicate to increase urethral tone - PPA, oestriol (f) testosterone (m)
What controls bladder relaxation?
Beta adrenergic fibres (sympathetic) from the hypogastric n
How is urethral tone maintained?
Alpha adrenergic fibres from the hypogastric n (Sympathetic)
How does the bladder contract?
Parasympathetic action of the pelvic n on the detruser muscle