WEEK 1: INCONTINENCE AND URINARY RETENTION Flashcards
What is urinary retention?
Who is it commonly found in?
Urinary retention (UR) can be defined as inability to achieve complete bladder emptying by voluntary micturition, and categorized as acute UR, chronic UR or incomplete bladder emptying. UR is common in elderly men.
For male patients, particularly in older age groups, what is comparatively common, usually as a consequence of benign prostate enlargement (BPE)?
For male patients, particularly in older age groups, bladder outlet obstruction (BOO) is comparatively common, usually as a consequence of benign prostate enlargement (BPE).
Most common in men in their fifties and sixties because of __________.
A woman may experience urinary retention if her bladder sags or moves out of the normal position, a condition called ________.
The bladder can also sag or be pulled out of position by a sagging of the lower part of the colon, in a condition called_________.
People of all ages and both sexes can have nerve disease or nerve damage that interferes with bladder function.
Most common in men in their fifties and sixties because of prostate enlargement.
A woman may experience urinary retention if her bladder sags or moves out of the normal position, a condition called cystocele.
The bladder can also sag or be pulled out of position by a sagging of the lower part of the colon, a condition called rectocele.
Outline causes of urinary retention.
-vaginal childbirth
-infections of the brain or spinal cord
-diabetes
-stroke
-accidents that injure the brain or spinal cord
-multiple sclerosis
-heavy metal poisoning
-pelvic injury or trauma
There are numerous causes now recognized in women, broadly categorized as infective, pharmacological, neurological, anatomical, myopathic and functional.
What are the symptoms of urinary retention?
Acute
Chronic
Acute urinary retention causes great discomfort, a pain, urgent need to urinate, the lower belly is bloated.
Chronic urinary retention, by comparison, causes mild but constant discomfort. Difficulty starting a stream of urine. Once started, the flow is weak dribbling of urine urge to urinate a condition called overflow incontinence.
Describe the diagnosis of urinary retention.
Urine Sample
A urine sample will be examined for signs of infection, which may be a cause or a result of urinary retention.
Bladder Scan
A bladder scan uses an ultrasound device that can determine how much urine is in the bladder.
Patient is asked to urinate, and then doctor or nurse will use the bladder scan to determine the post-void residual (PVR).
The word residual refers to the amount of urine left in the bladder after urinating.
How is urinary retention diagnosed?
How is urinary retention diagnosed?
History of Complaints and Physical Examination
A physician will suspect urinary retention by asking about the symptoms and will attempt to confirm the diagnosis with a physical examination of the lower abdomen.
The physician may be able to feel the distended bladder by lightly tapping on your lower belly. Tapping or striking for diagnostic purposes is called percussing.
State the diagnostic methods for urinary retention.
Rectal examination
PSA
CT abdomen pelvis
Prostate biopsy
Urodynamic tests
Rectal Examination:
Purpose: A rectal examination involves the insertion of a gloved, lubricated finger into the rectum to feel for abnormalities in the prostate gland. It is commonly performed as part of a routine physical examination or to assess the prostate’s size, texture, and any signs of irregularities, especially in the context of prostate cancer screening.
PSA (Prostate-Specific Antigen) Test:
Purpose: The PSA test measures the levels of a protein produced by the prostate gland in the blood. Elevated PSA levels can indicate various prostate conditions, including benign prostatic hyperplasia (BPH) or prostate cancer. However, an elevated PSA level does not necessarily confirm cancer, and further diagnostic tests may be needed.
CT (Computed Tomography) Abdomen and Pelvis:
Purpose: A CT scan of the abdomen and pelvis is a diagnostic imaging test that uses X-rays to create detailed cross-sectional images of the abdominal and pelvic regions. It is often used to evaluate the anatomy and detect abnormalities in organs such as the prostate, bladder, kidneys, and surrounding structures.
Prostate Biopsy:
Purpose: A prostate biopsy involves the removal of small tissue samples from the prostate gland for microscopic examination. It is typically performed when there are suspicions of prostate cancer based on elevated PSA levels or abnormal findings on a rectal examination. The samples are analyzed to determine whether cancer cells are present.
Urodynamic Tests:
Purpose: Urodynamic tests assess how well the bladder and urethra are storing and releasing urine. These tests are used to evaluate urinary incontinence, difficulties with urination, or other bladder-related issues. Urodynamic tests may include measuring bladder pressure, urine flow rate, and other parameters to diagnose and plan treatment for various urological conditions.
State 3 complications of urinary retention.
UTI
CKD
BLADDER DAMAGE
STATE 3 TREATMENT OF URINARY RETENTION METHODS
*CATHETERIZATION
*TREATMENT TO RELIEVE PROSTATE ENLARGEMENT
*WOMEN – TREATMENT OF RECTOCELE AND CYSTOCELE
What is urinary incontinence?
Urinary incontinence (UI), involuntary urination, is leakage of urine.
Impacts quality of life
Results from treatable underlying conditions often underreported.
State the causes of urinary incontinence in women.
Women:
- Stress urinary incontinence:
loss of support of the urethra which is usually a consequence of damage to pelvic support structures as a result of childbirth.
It is characterized by leaking of small amounts of urine with activities which increase abdominal pressure such as coughing, sneezing and lifting.
- Urge urinary incontinence is caused by uninhibited contractions of the detrusor muscle. It is characterized by leaking of large amounts of urine in association with insufficient warning to get to the bathroom in time.
- Polyuria (excessive urine production) of which, in turn, the most frequent causes are uncontrolled diabetes mellitus, primary polydipsia (excessive fluid drinking), central diabetes insipidus and nephrogenic diabetes insipidus. [Polyuria generally causes urinary urgency and frequency but doesn’t necessarily lead to incontinence.
Describe the pathophysiology of urinary incontinence.
Continence and micturition involve a balance between urethral closure and detrusor muscle activity.
Urethral pressure normally exceeds bladder pressure, resulting in urine remaining in the bladder. Normal voiding is the result of changes in both of these pressure factors: urethral pressure falls, and bladder pressure rises.
During urination, detrusor muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra.
At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body.
Incontinence will occur if the bladder muscles suddenly contract (detrusor muscle) or muscles surrounding the urethra suddenly relax (sphincter muscles).
Describe urinary incontinence in children.
Urination, or voiding, is a complex activity. The bladder is a balloon like muscle that lies in the lowest part of the abdomen.
The bladder stores urine, then releases it through the urethra, the canal that carries urine to the outside of the body.
Controlling this activity involves nerves, muscles, the spinal cord and the brain.
The bladder is made of two types of muscles:
The detrusor, a muscular sac that stores urine and squeezes to empty, and the sphincter, a circular group of muscles at the bottom or neck of the bladder that automatically stay contracted to hold the urine in and automatically relax when the detrusor contracts to let the urine into the urethra.
A third group of muscles below the bladder (pelvic floor muscles) can contract to keep urine back.
A baby’s bladder fills to a set point, then automatically contracts and empties.
As the child gets older, the nervous system develops. The child’s brain begins to get messages from the filling bladder and begins to send messages to the bladder to keep it from automatically emptying until the child decides it is the time and place to void.
Failures in this control mechanism result in incontinence. Reasons for this failure range from the simple to the complex.
Describe the diagnostic tests for urinary incontinence.
Stress test– the patient relaxes, then coughs vigorously as the doctor watches for loss of urine.
Urinalysis– urine is tested for evidence of infection, urinary stones, or other contributing causes.
Blood tests– blood is taken, sent to a laboratory, and examined for substances related to causes of incontinence.
Ultrasound– sound waves are used to visualize the kidneys, ureters, bladder, and urethra.
Cystoscopy– a thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder.