Urinaryincontinance

Question 1

the conscious control over micturition and defecation, and the ability to temporarily retain urine and feces, which is crucial for the social, psychological, and physical well-being of individuals.

Answer 1

Continence

Question 2

is the involuntary leakage of urine, and can be temporary or long-term due to various reasons such as trauma, stroke, or other health conditions

Answer 2

Urinary incontinence

Question 3

Factors required to ensure continence

Answer 3

Integrity of the bladder and urethra ( no injuries and infection)
The nervous structure should be intact
The position of bladder
The bladder dimension and capacity should be normal
Activity level and independent of the person ( mentally and physically )

Question 4

Pressure transmission

Answer 4

dynamic process increases urethral closure pressure and maintains continence to achieve urethral closure,

Question 5

Incontinence classified as

Answer 5

Overflowincontinence
Stress urinary incontinence
Urge urinary incontinence
Mixed urinary incontinence
Extraurethral incontinence
Reflexincontinence
Nocturnal enuresis
Giggle incontinence
Coital incontinence

Question 6

Overflow incontinence

Answer 6

Causes by bladder outlet obstruction or bladder doesn’t contract properly ( acontractile bladder hypotonic detrusor)
This lead to urine accumulating in the bladder until it reaches point where it can’t hold anymore causing leakage or overflow this leakage can be frequent or continuous also other diseases that can cause is diabetes spinal cord injury etc

Question 7

Stress urinary incontinence

Answer 7

Involuntary leakage of urine without detrusor contraction also it’s can be defined as urinary incontinence during physical movement and there’s insufficient in urethra

Question 8

Differentmechanismsareinvolvedinitsetiopathogenesis for stress urinary incontinence

Answer 8

Bladder neck hypermobility
Internal sphincter failure
Pelvic floor muscle weakness

Question 9

Urge urinary incontinence

Answer 9

is defined as involuntary urinary leakadge with a sudden urge to urinate.
It’s can be caused by Overactive destrusor functioning (motor urgency) and Hypersensitive bladder (sensory urgency)

It is determined by urodynamic tests.

Question 10

Mixed urinary incontinence

Answer 10

It’s coexistence of sui and uui symptoms together

Question 11

Extraurethral incontinence

Answer 11

It’s called the exit urine from different way outside the urethral canal
Can occur due to congenital disorder that creates urine to discharge into the vagina or traumatic causing opening btw the bladder and urethra and the vagina
for the treatment is usually with reconstruction surgery

Question 12

Reflex incontinence and nocturnal enuresis

Answer 12

For reflex: It is seen due to the suppression of the voiding center. Detrusor hyperactivity is a condition characterized by neurological
disorders such as involuntary relaxation of the urethra, and inability to detect urination
For nocturnal : it’s happens during sleep mostly childhood period to adolescence and if it’s continues there’s detrusor instability

Question 13

Giggle incontinence

Answer 13

Rare condition , during giggling or laughing
Mostly in adolescence girls
Due to the lower urethra closure pressure than normal

Question 14

Coital incontinence

Answer 14

Many women experience the urge to void or incontinence during or just after coitus.
It is thought that if urinary incontinence occurs during penetration, it may be related to stress incontinence, and if it occurs during orgasm, it may be due to detrusor instability.

Question 15

Risk factors of urinary incontinence

Answer 15

Age
Obesity
Menopause pelvic floor muscle weakness
Pregnancy and brith
Smoking
Pelvic traumas and surgeries

Question 16

Assessment

Answer 16

1: neurological assessments:
2: evaluation of pelvic floor muscles strength
3: clinical test
4: bladder diaries
5: urodynamic testing
6: radiographic evaluation ( MRI AND ultrasonography)
7: quality of life assessment
8: assessment of sexual function

Question 17

Neurological assessment

Answer 17

Assess of pudendal nerve and s2-4 scar reflex

Superficial sensory evaluation of the perineum and perianal region can be easily evaluated with a blunt-tipped instrument,
the bulbocavernous reflex can be easily evaluated by contacting the clitoris with a cotton-tipped swab.

Question 18

Evaluation of pelvic floor muscles strength

Answer 18

1. Visual observations
2. Vaginal palpitations method: pelvic floor muscle strength
   3: biofeedback methods: for measuring the strength of voluntary contractions of the pelvic floor muscle
   4: pelvic floor dynamometer: measure the force released during muscle contraction independent of the evaluator
   5: stop test : for evaluate pelvic floor muscle strength

Question 19

Clinical test

Answer 19

Stress test
Pad test
C Q tip test
Urine analysis and urine culture

Question 20

Treatment

Answer 20

Conservative treatment
Pharmacological treatment
Surgical treatment

Question 21

Conservative treatment

Answer 21

Behavioral therapy
Electronical stimulation

Question 22

Behavioral therapy

Answer 22

Cognitive learning principles, low cost, few side effects
Divided into
Pelvic floor muscle exercises
Biofeedback
Vaginal cone
Bladder training
Diet

Question 23

Electrical stimulation

Answer 23

normalises the reflex activity of the lower urinary tract and increases circulation to muscles and the capillary system.

Low frequency current (faradic current)
Interferential current