Week 13: Chp 63: Incontinence Flashcards
Urinary Incontinence
involuntary or uncontrolled loss of urine in any amount
Micturition
voiding/ urination
Micturition cycle
involves a complex interplay between the sympathetic and parasympathetic nervous systems
- Parasympathetic nervous system provides motor stimulation to the bladder and mediates bladder contraction
- Sympathetic nerves mediate bladder storage by stimulating contractions in the bladder neck and proximal urethra, blocking urine flow
If perceived as an appropriate time to void, what is voluntarily relaxed, allowing urine to flow into the urethra?
external urethral sphincter
What results in an areflexic (flaccid) bladder, resulting in retention with overflow?
injuries or lesions at the level of S2 to S4 or below
Types of Incontinence
- stress incontinence
- urge incontinence
- Overflow
- Functional
- reflex
Stress Incontinence
urine leakage occurs when abdominal pressure increases; laughing, coughing, lifting, or exercising
-causes/risk factors: common in women, childbirth (which causes stretching and relaxing of pelvic floor muscles, ligaments, and urethra), postmenopausal women, smoking, obesity)
Urge Incontinence
strong urge to urinate followed by uncontrolled leakage
-Causes/risk factors: exposure to bladder irritants such as caffeine, artificial sweeteners, or nicotine
Overflow Incontinence
frequent urination
-causes/risk factors: flaccid/enlarged bladder due to obstruction (e.g enlarged prostate), spinal cord injury, stroke, diabetes, neurological diseases
Functional Incontinence
patient is continent but environmental factors lead to loss of urine in inappropriate areas
-causes/risk factors: inability to get to the toilet or communicate the need to do so
Reflex Incontinence
bladder muscle contracts on its own, urethral sphincters exhibit varying control
-causes/risks: disorders that affect the nervous impulse for voiding such as multiple sclerosis, brain tumors, or stroke
What is the first step in managing Urinary incontinence?
a realization on the part of the patient that incontinence is not a normal part of the aging process and that it is often treatable and always manageable
How to diagnose Incontinence
starts with a thorough history; should include medical, urological, voiding, neurological, and reproductive history
- be questioned as to management routines and patterns of incontinence and voiding characteristics
- a voiding diary is useful
- a physical should include a neurological assessment and examination of genitalia
Laboratory Testing for Incontinence
begins with urine culture and urinalysis, which may rule out infection and/or illness such as uncontrolled diabetes mellitus as factors
-blood test
Blood Tests for incontinence
associated with renal function
-BUN/Cr
>reveal the effects of bladder function on the upper urinary tracts
Imaging studies
- plain x-rays or films of the kidneys, ureters, and bladder (KUB)
- IV pyelogram
- voiding cystourethrogram (VCUG)
- Ultrasound
- Urodynamic testing (uroflowmetry)
- cystometrogram (CMG)
IV pyelogram
an x-ray of the renal system with IV contrast solution to facilitate imaging
Voiding cystourethrogram (VCUG)
uses contrast dye injected into the bladder to enable visualization of the voiding process
Ultrasound
provide useful information about the urinary tract without exposing the patient to radiation
Urodynamic Studies; uroflowmetry
measures the transport, storage, and elimination functions of the urinary tract
-uroflowmetry tests the urinary flow rate in millimeters per second
Cystometrogram (CMG)
assess the bladders filling and storage function
- graphically represents bladder pressure compared with volume while the bladder is filled with liquid
- often coupled with a sphincter electromyogram
Primary goal of treatment
to prevent or stop urinary leakage
-prevention or reduction of damage to the upper tracts or the kidneys, manifested by deteriorating renal function
What if it is not possible to stop or prevent urinary leakage?
containment with scrupulous skin care and odor control becomes the new objective
Management of Incontinence is based on what?
the type of incontinence and is done with medications, nonsurgical measures, or surgical measures if the medications or nonsurgical means have not worked