W12 Urine transport Flashcards
what are the three main components of the urinary tract
ureters
urinary bladder
urethra
what is the role of the micturition reflex
coordinates the process of urination
describe the 4 main stages in the micturition reflex
sensory fibers in the pelvic nerve sense stretch due to bladder filling
parasympathetic fibers control muscle contraction
interneurons communicate signals up to hypothalamus with relays into the cortex
voluntary relaxation of external sphincter results in urination
what do stretch receptors do as the urinary bladder fills
stimulate pelvic nerve
where does the stimulus from the pelvic nerve travel too
stimulates ganglionic neurons in wall of bladder
what does the postganglionic neuron in intramural ganglion do
stimulates detrusor muscle contraction
what relays sensation to thalamus and deliver sensation to cerebra cortex
interneuron
what results from the relaxation
relaxation of internal urethral sphincter
what two age ranges affect the micturition reflex
babys as they do not have the connections between the bladder and the hypothalamus are not mature
elderly reflex becomes impaired leading to incontinence.
what can loss of control micturition reflex be caused by
a stroke
alzheimer’s disease
CNS problems affecting cerebral cortex or hypothalamus
enlarged prostate
what is incontinence
involuntary loss of urine that is enough to cause a social or hygiene concern
what is chance of incontinence in female vs male
x4 in woman
what can stress incontinence be caused by
coughing
sneezing
laughing
carrying heavy weights
what is stress incontinence
anything that puts pressure on the bladder
when does stress incontinence occur
when the urethra moves out of the normal position (prolapses) after weakening of the pelvic floor muscles.
In woman what are some other causes of stress incontinence
childbirth
hysterectomy
menopause
what is urge incontinence
strong urge to pass frequent small amounts of urine.
what is urge incontinence caused by
muscle of the bladder wall known as the detrusor being overactive meaning it contracts to squeeze out urine before the bladder is completely full
what is mixed incontinence
some woman get both urge and stress and they can be liked but not always
what is overflow incontinence
when urine held by the bladder builds up to the point where the bladder can no longer expand.
what is overflow incontinence also known as
chronic urinary retention
what is overflow incontinence caused by
obstruction in urinary tract or damage to the nerves that supply the bladder
what might obstruction be due to
stones
constipation
benign pro static hypertrophy
what conservative treatments can be used to help
pelvic floor muscle training
bladder training
- scheduled toileting every 2-4 hours
frequently empty the bladd and thereforre keep the patient dry
what is duloxetine used for
moderate to severe stress urinary incontinence
what can duloxetine help with
increasing the muscle tone of the urethra which should help keep it closed
what are sub indications of duloxetine
depression and neuropathic pain
what are some possible side effects of duloxetine
nausea
dry mouth
fatigue
what do antimuscarinic drugs do
reduce contractions of bladder and increase bladder activity (urge incontinence)
what effect does antimuscarinic drugs have
reduce symptoms of urgency and increase bladder capacity
what are some examples of antimuscarinic drugs
Oxybutynin (DITROPAN)
Tolterodine (DETRUSITOL)
Solifenacin (VESICARE)
what are some side effects of antimuscarnic side effects
dry mouth constipation blurred vision dry eyes fatigue drowsiness confusion difficulty in micturtion angle close glaucoma arrythmias and tachycardia
what forms of incontinence can be treated surgically
all 3
when should surgical correction be considered
only after all conservative options have been exhausted
what complications can occur
infection
bleeding
continued incontinence
inability to urinate
where is the prostate located
surrounds the urethra
what is the enlargement of the prostate known as
benign prostatic hyperplasia BPH
what is the problem with prostate enlargement
it presses down on the urethra and cause urination and bladder problems
when does the likely hood of prostate enlargement increase
as age increase
what is the role of alpha 1 blockers
they are a class of medication used to treat high blood pressure and allow easier urination as it relaxes the muscle of the bladded,neck and prostate.
what is the role of finasteride and dutasteride
lower levels of hormones produced by the prostate, reducing the size of the prostate gland increasing urine flow rate and decrease symptoms of BPH it may take 3-6 months for improvement in symptoms.
