Urinaryincontinance Flashcards
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.
Continence
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
Urinary incontinence
Factors required to ensure continence
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 )
Pressure transmission
dynamic process increases urethral closure pressure and maintains continence to achieve urethral closure,
Incontinence classified as
Overflowincontinence
Stress urinary incontinence
Urge urinary incontinence
Mixed urinary incontinence
Extraurethral incontinence
Reflexincontinence
Nocturnal enuresis
Giggle incontinence
Coital incontinence
Overflow incontinence
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
Stress urinary incontinence
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
Differentmechanismsareinvolvedinitsetiopathogenesis for stress urinary incontinence
Bladder neck hypermobility
Internal sphincter failure
Pelvic floor muscle weakness
Urge urinary incontinence
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.
Mixed urinary incontinence
It’s coexistence of sui and uui symptoms together
Extraurethral incontinence
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
Reflex incontinence and nocturnal enuresis
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
Giggle incontinence
Rare condition , during giggling or laughing
Mostly in adolescence girls
Due to the lower urethra closure pressure than normal
Coital incontinence
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.
Risk factors of urinary incontinence
Age
Obesity
Menopause pelvic floor muscle weakness
Pregnancy and brith
Smoking
Pelvic traumas and surgeries
Assessment
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
Neurological assessment
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.
Evaluation of pelvic floor muscles strength
- Visual observations
- 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
Clinical test
Stress test
Pad test
C Q tip test
Urine analysis and urine culture
Treatment
Conservative treatment
Pharmacological treatment
Surgical treatment
Conservative treatment
Behavioral therapy
Electronical stimulation
Behavioral therapy
Cognitive learning principles, low cost, few side effects
Divided into
Pelvic floor muscle exercises
Biofeedback
Vaginal cone
Bladder training
Diet
Electrical stimulation
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
