Urinary L7.2 Flashcards
What are Rugae?
What is a key difference between internal and external sphincter?
Folds in bladder wall
Folds flatten
Make bladder distensible
INVAGINATIONS(folds) THAT DISAPPEAR WHEN BLADDER IS FILLED.
What is urinary incontinence (UI)?
What are risk factors for UI?
Types of UI (inability to control urination)
UTIs - Chemical irritation from infection increases bladder activity, more frequent urge to void
Stress Incontinence (Women): due to pelvic floor injury, commonly after childbirth. Weakened pelvic muscles cause urine leakage during activities like coughing, sneezing, or exercise.
Age-Related Incontinence (Elderly): Muscle tone loss in bladder, pelvic floor
Detrusor Overactivity (Overactive Bladder): More frequent contractions of detrusor muscle (or involuntary). Common older patients
Neurological damage:
CNS, spinal cord, nerve supply damage.
e.g. AUTOMATIC BLADDER. Seen in Alzheimer’s disease
Pelvic Nerve Damage
Types of urinary retention
Inability to empty bladder
- Prostate enlargement (men)
Benign prostatic hyperplasia. Obstruct flow of urine, therefore, urinary retention - Kidney stones
Stones in urinary tract, block flow of urine, therefore, inability to empty bladder
Describe how the bladder and urethra have reciprocal function
During filling:
-Bladder relaxed, low intravesical pressure
-Urethra: generates high resistance to prevent urine leakage
During emptying:
-Bladder:Bladder contracts and therefore intravesical pressure rises to overcome outflow resistance
-Urethra: drastic decrease in outflow resistance
Lower Urinary Tract Symptoms (LUTS)
Classification of LUTS: storage symptoms:
- Frequency
- Urgency
- Nocturia
- Incontience - involuntary leakage of urine
What are the different types of incontinence?
What are the causes of incontinence?
- Over Active: Involuntary contractions of detrusor muscle. Symptoms: urinary urgency, frequency, nocturia, may occur with or without urge urinary incontinence (involuntary leakage of urine without feeling urge to urinate)
This is all normally caused by nerve damage (Parkinson’s disease, stroke, miltipke sclerosis) - Stress incontinence: Pressure (stress) on bladder leads to utine leakage. Pressure from physical movements (anything that increases abdomen pressure).
Triggers: Coughing, sneezing, phsyical activity. Not related to psychological stress. Main cause: muscle problems (e.g. weakned pelvic floor muscles)
1) What is Stress Urinary Incontinence?
2) What are triggers for SUI?
3) What is the main cause?
4) Which patients is this most common in?
1) Involuntary leakage of urine, due to increase abdominal pressure
2) Sneeze, cough, exercise
3) Weakness of pelvic floor muscle / sphincter mechanism. (muscles + sphincter hold urine in bladder, but when weakened, do not properly resist pressure, leads to leakage)
4) Women (after birth / during menopause). Menopasue reduces oestrogen levels, weakens pelvic + bladder tissues. Men (after prostate surgery). weakens urinary sphincter)
1) What is Urge Urinary Incontinence (UUI)?
2) Main causes
3) Symptoms
4) What type of patients is this common in?
1) sudden, intense urge to urinate. Leads to involuntary loss of urine before reaching bathroom. Associated with OAB
2) Bladder inflammation or infection (UTI)
Neurological conditions (Parkinsons, stroke, multiple sclerosis)
3) Frequent need to urinate
Urgency
Nocturia
4) Elderly
1) What is neurogenic Urinary Incontinence?
2) Main causes
3) Symptoms
1) Loss of bladder control / loss of sensation of bladder fullness due to nerve damage
2) Nerve damage (diabetes, alcoholism, Vit B12 defiiency, pelvic surgery damage nerves that control bladder). Brain/spincal cord injury. Neurological conditions (MND, spnfa bifida)
3) Loss of control of urination.
1) What is overflow incontinence?
2) Main causes
1) Urine leakage because bladder unable to empty completely,leading to gradual build up of urine and overflow.
2) Blockage/obstruction preventing urien from leaving bladder. E.g. ENLARGED PROSTATE in men. This partially blocks urethra, preventing normal urine flow.
Imparied bladder contraction: Detrusor muscle unable to contract properly to fully empty bladder. Due to nerve damage / weakened bladder muscles
Result:
Bladder fills up but does not completely empty. Eventuallu, excess urine leaks out in small amounts.
Person does not feel need to urinate, still experiences involuntary leakage.
1) What is functional incontinence?
2) Main causes
3) Which patients are most commonly affected?
1) Bladder control is normal, but person is ubale to reach bathroom in tume due to physical or cognitive impairment
2) Physical impairments: difficulty moving. e.g. arthritis
Cognitive impairments: dementia, alzheimers
3) Elderly (environmental barriers e.g. distance to bathroom, make it worse)
1) What is mixed urinary incontinence? (MUI)
2) Common combinations
1) Presence of more than one type of incontinence (most common combination: stress + urge incontinence)
2) Stress incontinence
Urge incontinence
Describe
-management
-treatment
-prevention
for urinary incontinence
- Bladder training: scheduled voiding
- Pelvic floor exercises: strengthens pelvic floor muscles. Very good for stress incontiennce
- Pharma interventions
anticholinergics, beta-3 agonists - Surgical options: sling proceadures, bladder neck suspension
- Devices, aids: catheters (for urinary retention to help empty bladder)
- Lifestyle Modifications (Diey, weight management)
- Early intervention strategies (implement blradder training, pelvic floor exercises early)
What are 3 mechanisms contributing to OAB?
- Increased afferent activity. Hightened sensory signals fro, bladder to brain
- Decreased inhibitory control in CNS.
Increased detrusor muscle sesnitivity to efferent stimulation. (more frequent, involuntary contractions)
Surgical management *
