Urinary Retention and Incontinence Flashcards
List the structures involved in urinary continence
External urethral sphincter
Internal urethral sphincter
Well vascularised urethral mucosa and submucosa
Intact pelvic floor
Describe the nerve supply to the bladder
Sympathetic= hypogastric nerve causes relaxation of the bladder detrusor muscle resulting in urinary retention
Parasympathetic= pelvic nerve causes contraction of the bladder detrusor muscle resulting in micturition
Somatic= pudendal nerve allows for voluntary control over micturition so can constrict or relax
What is the bladder stretch reflex?
As the bladder fills with urine, the bladder walls stretch. Sensory nerves detect the stretch and transmit to the spinal cord where the parasympathetic nerves are stimulated to cause micturition.
The reflex is non-functional post-childhood except in spinal injuries and neurodegenerative disease
What is stress urinary incontinence?
Pelvic floor is not strong enough to hold the urine in the bladder when intra-abdominal pressure rises eg. coughing, sneezing, laughing
What is overflow urinary incontinence?
Patient does not feel any urge to urinate so bladder leaks urine
What is urge urinary incontinence?
Frequent strong urges to urinate due to involuntary and inappropriate contractions of the detrusor muscle.
What is functional urinary incontinence?
No problem with urinary tract but patient voids in socially unacceptable situation. Can be behavioural or unintentional eg. poor mobility
Give 3 complications of urinary incontinence
Physical inactivity- leads to weight gain Emotional distress- depression, anxiety Intimacy problems Nocturia Urinary retention Dribbling urine
What is urinary retention? What is the difference between acute and chronic?
Inability to fully empty the bladder
Acute: cannot urinate at all, occurs suddenly and lasts a short time. Can be life-threatening
Chronic: long term problem, patients can urinate but do not fully empty the bladder
Give 4 causes of a urethral obstruction
BPH- prostate enlargement Urethral stricture Urinary tract stones Cystocele/rectocele Constipation Tumours/cancers
Give 4 medications that can cause urinary retention
Antihistamines Anticholinergics TCAs Opioids Decongestants Nifedipine Carbamazepine NSAIDs
Give 2 causes of nerve damage that can cause urinary retention
Diabetes Childbirth Stroke MS Trauma
Give 3 symptoms of urinary retention
Pain in lower abdomen Painful, urgent need to urinate Palpable bladder Bloating Inability to urinate Weak stream
How is urinary retention diagnosed?
Post-void bladder scan
Cystoscopy
CT scan
Urodynamic tests
How is urinary retention treated?
Bladder drainage- catheterisation Urethral dilation Urethral stents Prostate medications Prostate surgery
